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Why does gender equality matter for development?
2
What does this Report do?
6
Where has there been the most progress in gender equality?
Where have gender inequalities persisted and why?
13
What is to be done?
22
The political economy of reforms for gender equality
35
A global agenda for greater gender equality
36
Notes
38
References
40

Introduction: A guide to the Report

46

Gender equality and development: Why do the links matter?
What does this Report do?
48
Navigating this Report: A roadmap
50
Notes
51
References
51

Part II What has driven progress? What
impedes it?
98
Explaining the framework
Applying the framework
Notes
102
References
102

99
101

3 Education and health: Where do gender differences
really matter?
104
Endowments matter
105
Education
106
Health
117
Technical Annex 3.1 Computing the flow of missing girls at birth and excess
female mortality after birth
139
Chapter summary: In reducing gender gaps in education and health,
tremendous progress has been made where lifting a single barrier—in
households, markets, or institutions—is sufficient to improve outcomes.
Progress has been slower either where multiple barriers need to be lifted
at the same time or where a single point of entry produces bottlenecks
141
Notes
142
References
143

9 A global agenda for greater gender equality
Rationale for and focus of a global agenda
What to do and how to do it
362
Notes
370
References
371

Bibliographical Note

373

Background Papers and Notes
Selected Indicators

377

381

Selected World Development Indicators
Index

360

360

389

411

Boxes
1 What do we mean by gender equality?

4

2 The Millennium Development Goals recognize the intrinsic
and instrumental value of gender equality
4
3 How women and men define gender in the 21st
century
7
4 What do we mean by markets, formal institutions, and
informal social institutions?
8
5 Reducing maternal mortality—What works? Look at
Malaysia and Sri Lanka
25
6 Catalyzing female employment in Jordan

29

7 Intervening early to overcome future labor market failures—
The Adolescent Girls Initiative
34
0.1 Problems with estimating the effect of gender equality on
growth
49
1.1 Gender and the Millennium Development Goals
2.1 The many faces of climate change

86

3.1 Adult mortality risks: Who are the outliers?
3.2 Four Africas

135

119

58

ix

Contents

4.1 Pensions—Coverage, amounts, and survivor benefits are
important for women’s autonomy
156

6.3 Occupational tasks and skill requirements—Getting the
terms right
259

5.5 Good jobs and bad jobs: What are they and who does
them?
211
5.6 The seeds of segregation are planted early—How gender
differences in education trajectories shape employment
segregation
216
5.7 Overview of data used in analyzing gender differences in time
use patterns
218

8.4 More women in public office—The Namibian Women’s
Manifesto Network
335
8.5 Differences among women about their right to vote—
The case of Switzerland
336
8.6 Domestic workers in Brazil

337

5.8 What did you do all day? Perceptions on time use patterns of
the opposite sex
221

8.7 How popular culture can change social attitudes

5.9 Gender of the household head versus household
composition: What matters most for policy?
225

8.9 Land titling in Peru—Using a gender lens for a genderneutral program
346

5.11 The business case for gender equality

8.8 Four good practices for greater gender diversity

8.10 Gender machineries in practice

5.10 Family formation and public sector employment in
Egypt
232

339
342

347

8.11 Courts and constitutional challenges in Uganda’s divorce
law
348

238

8.12 Fiji: International norms as a driver of gender equality in
family law
349

6.2 The impact of globalization on men (and women) in
developed countries
259

353

8.15 Sweden—Encouraging an involved fatherhood

353

Figures
5 Female labor force participation has increased over time at
all income levels
12

1 Gender outcomes result from interactions between
households, markets, and institutions
9
2 Across the world, women are having fewer children

9

3 Gender parity in enrollments at lower levels has been
achieved in much of the world, but tertiary enrollments are
very low and favor women
10
4 Using the framework to explain progress in
education
11

6 Low-income countries lag behind in realizing progress in
female school enrollment
13
7 Female disadvantage within countries is more marked at
low incomes
14
8 Women and men work in different sectors

16

9 Explaining persistent segregation and earnings gaps

18

x

CONTENTS

10 Across the world, women spend more hours per day on care
and housework than men
19
11 Gender differences in agricultural productivity disappear
when access to and use of productive inputs are taken into
account
20
B0.1 GDP per capita and gender equality are positively
correlated
49
1.1 Gender parity in enrollments at lower levels has been
achieved in much of the world, and tertiary enrollments
now favor women
61
1.2 Gender explains little of the inequality in education
participation for children 12–15 years old
63
1.3 Women are living longer than men

64

1.4 What took the United States 100 years took India 40 and
the Islamic Republic of Iran 10
64
1.5 Gender explains little of the inequality in use of preventive
health services
65
1.6 The gender gap in labor force participation narrowed
between 1980 and 2008
66
1.7 Across countries, at every income level, female labor force
participation increased between 1980 and 2008
66
1.8 Who agrees that a university education is more important for
a boy than for a girl?
68
1.9 Who agrees that when jobs are scarce, men should have more
right to a job than women?
68
2.1 Female enrollments remain strikingly low in some
countries
73
2.2 In some countries, female disadvantage augments at lower
incomes . . .
74
2.3 . . . yet in others, at low levels of wealth girls stay longer in
school than boys
75
2.4 At low incomes, fertility rates remain high—And the poorer
the country, the larger the gap between rich and poor
76

3.1 Gender parity in enrollments at lower levels has been
achieved in much of the world, but tertiary enrollments are
very low and favor women
107
3.2 In most countries with moderate or high total inequality in
educational outcomes, less than one-fifth of inequality stems
from gender
108
3.3 What explains progress in school enrollments?

3.8 Income growth did not reduce excess female mortality during
1990–2008 in low- and middle-income countries
123
3.9 Why are so many girls missing at birth?

124

3.10 There is little or no gender disadvantage in vaccination rates,
nutrition outcomes, or use of health services when a child
falls sick
126
Small differences do not explain the variation in the fraction
of excess deaths across countries
126
3.11 Men and women, boys and girls, are treated the same when
they visit health facilities
127
3.12 Levels of excess female childhood mortality in high-income
countries in the early 1900s were similar to those of low- and
middle-income countries today . . .
128
. . . and the excess female mortality declined with reduction in
overall childhood mortality
128
3.13 Maternal mortality ratios declined steeply in selected
countries during 1930–60
129
3.14 High income countries today had excess female mortality
at the reproductive ages during the first half of the
20th century . . .
130
. . . and the excess mortality at all income levels declines with
reductions in maternal mortality
130

2.5 Maternal mortality in many developing countries is similar to
that in Sweden before 1900
78

3.15 What explains excess mortality among girls and women in
the reproductive ages?
131

2.6 Women are more likely than men to work in the informal
sector
79

3.16 Excess female mortality by age in four countries with high
HIV prevalence
132

2.7 Women and men work in different sectors (and different
occupations)
80
2.8 Across the world, women spend more hours each day on
housework and care than men . . . and men spend more time
in market activities
81
2.9 Who controls women’s own income?

82

2.10 Perceptions in many nations are that wife-beating is
justifiable
83

3.17 In some countries, there is excess male mortality
3A.1 Sex ratio and age-specific mortality, 2008

133

139

3A.2 Excess female mortality globally at each age in 2008 using
various reference groups
140
4.1 Witnessing violence as a child is associated with perpetrating
violence as an adult
152

2.11 There is great heterogeneity in rates of domestic violence
reported across nations
84

4.5 Form of acquisition of land by gender in six Latin American
countries
155

5.9 Women bear the brunt of housework and care while men are
mostly responsible for market work
219

4.6 Working outside the home broadens men’s and women’s
networks (almost) equally
157

5.10 Convergence in gender time use patterns is stronger for
market work than for housework and care work
220

4.7 In most countries, access to contraceptives is a less significant
constraint than lack of knowledge and opposition to
contraception
158

5.11 In Mexico and Thailand, married women are more likely to
move between inactivity and informal self-employment than
men and single women
222

4.8 Progress on inheritance is faster for daughters than for
widows
160

5.12 Female-headed households are less likely to own and operate
land than male-headed households
226

4.9 Few women seek services in case of domestic violence

168

4.10 Education dampens normative constraints more than
income
169
4.11 Despite differences in the age of marriage, many girls still
marry before the age of 18
170
4.12 Reasons why victims of violence do not seek help

171

4.13 Even in 2010, women ministers were twice as likely to hold a
social portfolio than an economic one
177
4.14 Women’s voice in society is limited by social norms
on women’s roles and abilities and by formal
institutions
178

4.16 Women are much less likely to belong to a political party
than men
179
156

5.15 Mutually reinforcing market and institutional constraints are
the main reason why women appear to be in a productivity
trap
237
200

B5.8.1 Understanding the amounts of time the opposite sex spends
on nontraditional male/female activities and leisure
221
6.1 Global trade has grown rapidly since 1990

B4.3.2 Husband’s family receives the majority of his assets in most
countries
163
202

5.2 Women are overrepresented among wage and unpaid family
workers
207
5.3 Gender differences in agricultural productivity diminish
considerably when access to and use of productive inputs are
taken into account
208
5.4 Differences in productivity between female and male
entrepreneurs are dwarfed by differences in productivity
between formal and informal entrepreneurs
208
5.5 Economic development is positively correlated with the
share of female workers in wage employment and negatively
correlated with the share of women in unpaid work, selfemployment, and entrepreneurship
212
5.6 Tanzania and Brazil illustrate how employment patterns by
gender change with economic growth
213
5.7 Industry and occupational segregation patterns are common
across countries with very different levels of economic
development and aggregate sectoral distributions of
employment
214
5.8 Access to economic opportunities and the resulting
segregation in employment are the product of households,
markets, and institutions, and their interactions
217

255

6.2 Cell phone and Internet access has increased significantly in
both developed and developing countries
256
6.3 Economic opportunities have changed

B4.3.1 Elderly women are more likely to live alone and elderly men
with their spouses
163

5.1 There are systematic gender differences in earnings

5.14 Access to productive inputs and markets is lower among
female-headed households than among male-headed
households
228

B5.1.1 Participation rates—Converging

4.15 Perceptions on leadership skills are still very prevalent, and
less educated cohorts are more biased
179

B4.1.1 Sources of income for China’s elderly, 2005

5.13 Female-headed households in rural areas are less likely
than male-headed households to have received credit in the
last 12 months
227

257

6.3a Female (and male) employment in the manufacturing and
service sectors has grown faster in developing countries,
reflecting the broader changes in the global distribution of
production and labor
257
6.3b . . . and increases in female employment levels (but not male)
between 1995 and 2005 were correlated with increases in
international trade
257
6.4 The United States experienced a dramatic increase in brain
requirements and a decline in brawn requirements between
1950 and 2005
260
6.5 Men and especially women in Brazil, India, Mexico, and
Thailand have experienced an increase in brain requirements
and a decline in brawn requirements over the past 15
years
261
6.6 In Africa, women are less likely than men to own or use a
cell phone
262
6.7 Differences in Internet access and use between developed
and developing countries are still very large, and gender
gaps are significant in some developed and developing
countries
263
6.8 Telework has grown rapidly in recent years, particularly
among female workers
265
6.9 The share of female employment varies significantly across
industries
266
6.10 The number of countries that have ratified CEDAW has risen
in all regions to reach 187, of 193, in 2011
266

8.5 State action is central for the design and adoption of
gender-progressive policies
345

281

283

P2.1 Gender outcomes result from interactions between
households, markets, and institutions
101

Maps
1 Earnings gaps between women and men

17

B4.2.1 Women in different parts of the world have different
control over assets—Which matters in case of divorce or
the husband’s death
162

0.1 Economies where qualitative assessments were
conducted
50
3.1 In China and India, the number of girls missing at birth
remains high, and parts of Africa experienced large increases
in excess female mortality during 1990–2008
122
4.1 In Sub-Saharan Africa, customary laws are formally
recognized in most countries, and at times are
discriminatory
166

5.1 Gender differences in occupation and industry of
employment account for a large fraction of the gender gap
after accounting for individual characteristics
209
B5.1.1 Female labor force participation—Some high rates and
some low
199

Tables
1 Almost 4 million missing women each year
2 The agenda for global action at a glance

15
38

2.1 Missing girls at birth increased between 1990 and 2008 in
India and China, as did excess female mortality in adulthood
in Sub-Saharan Africa
77
3.1 Gender segregation in field of study: In most countries,
women dominate health and education studies and men
dominate engineering and sciences
115

3.2 Skewed sex ratios at birth and excess female mortality
persist across the world, leading to females missing at birth
and excess female mortality during childhood and the
reproductive years
121
5.1 Female farmers have lower average productivity than male
farmers
202
9.1 The agenda for global action at a glance

361

Foreword

The lives of girls and women have changed dramatically over the past quarter century. Today,
more girls and women are literate than ever before, and in a third of developing countries,
there are more girls in school than boys. Women now make up over 40 percent of the global
labor force. Moreover, women live longer than men in all regions of the world. The pace of
change has been astonishing—indeed, in many developing countries, they have been faster
than the equivalent changes in developed countries: What took the United States 40 years to
achieve in increasing girls’ school enrollment has taken Morocco just a decade.
In some areas, however, progress toward gender equality has been limited—even in developed countries. Girls and women who are poor, live in remote areas, are disabled, or belong
to minority groups continue to lag behind. Too many girls and women are still dying in childhood and in the reproductive ages. Women still fall behind in earnings and productivity, and
in the strength of their voices in society. In some areas, such as education, there is now a gender gap to the disadvantage of men and boys.
The main message of this year’s World Development Report: Gender Equality and Development is that these patterns of progress and persistence in gender equality matter, both for
development outcomes and policy making. They matter because gender equality is a core
development objective in its own right. But greater gender equality is also smart economics,
enhancing productivity and improving other development outcomes, including prospects for
the next generation and for the quality of societal policies and institutions. Economic development is not enough to shrink all gender disparities—corrective policies that focus on persisting gender gaps are essential.
This Report points to four priority areas for policy going forward. First, reducing gender
gaps in human capital—specifically those that address female mortality and education. Second, closing gender gaps in access to economic opportunities, earnings, and productivity.
Third, shrinking gender differences in voice and agency within society. Fourth, limiting the
reproduction of gender inequality across generations. These are all areas where higher incomes
by themselves do little to reduce gender gaps, but focused policies can have a real impact.
Public actions need to address the underlying determinants of gender gaps in each priority area—in some cases, improving service delivery (especially for clean water, sanitation,
and maternal care), for others, tackling constraints that originate in the workings of markets and institutions to limit progress (for example, in reducing gender gaps in earnings and
productivity).
Development partners can complement public action. In each of the four priority areas,
efforts need more funding (particularly to support the poorest countries as they address
female mortality and gender gaps in education); better gender-disaggregated data; more
experimentation and systematic evaluation; and broader partnerships that include the private
sector, development agencies, and civil society organizations.

xiii

xiv

F O R E WO R D

Gender equality is at the heart of development. Itâ&#x20AC;&#x2122;s the right development objective, and
itâ&#x20AC;&#x2122;s smart economic policy. The World Development Report 2012 can help both countries and
international partners think through and integrate a focus on gender equality into development policy making and programming.

Robert B. Zoellick
President
The World Bank Group

Acknowledgments

This Report has been prepared by a core team led by Ana Revenga and Sudhir Shetty, and
comprising Luis Benveniste, Aline Coudouel, Jishnu Das, Markus Goldstein, Ana María
Muñoz Boudet, and Carolina Sánchez-Páramo. Research assistance was provided by
Rabia Ali, María Inés Berniell, Rita Costa, Nina Rosas, and Lucía Solbes Castro. The multicountry qualitative assessment was coordinated by Patti L. Petesch and Carolyn Turk. Extensive
and valuable contributions were made by Andre Croppenstedt, Malcolm Ehrenpreis, Rebekka
Grun, Mary Hallward-Driemeier, Tazeen Hasan, Karla Hoff, Ghazala Mansuri, Claudio E.
Montenegro, and Bob Rijkers.
The World Development Report 2012 is co-sponsored by the Development Economics Vice-Presidency (DEC) and the Poverty Reduction and Economic Management VicePresidency (PREM). The work was conducted under the joint guidance of Justin Yifu Lin in
DEC and Otaviano Canuto dos Santos Filho in PREM. Ann E. Harrison and the DEC team
and Mayra Buvinic and the PREM Gender (PRMGE) team provided valuable guidance and
contributions at various stages of the production of this report.
A panel of advisers comprising Bina Agarwal, Ragui Assad, Anne Case, Alison Evans, Raquel
Fernández, Naila Kabeer, Ravi Kanbur, Santiago Levy, and Germano Mwabu provided excellent advice. Valuable comments and contributions were provided by Kathleen Beegle, Laura
Chioda, Louise Cord, Maria Correia, Monica Das Gupta, Shantayanan Devarajan, Marianne
Fay, Francisco H. G. Ferreira, Ariel Fiszbein, Indermit Gill, Alejandro Hoyos, Emmanuel Jimenez, Elizabeth King, Andrew Mason, William Maloney, Ambar Narayan, Pierella Paci, Tara
Vishwanath, and Michael Walton. Many others inside and outside the World Bank contributed with valuable comments and input (their names are listed in the Bibliographical Note).
World Bank President Robert B. Zoellick and Managing Directors Sri Mulyani Indrawati,
Mahmoud Mohieldin, and Ngozi Okonjo-Iweala provided invaluable guidance and advice.
The team benefited greatly from many consultations, meetings, and regional workshops
held locally and in-country. These discussions included policy makers, civil society representatives, academics, and development partners from Benin, Bolivia, Burkina Faso, Burundi, the
Caribbean nations, the Central African Republic, Chile, Colombia, the Dominican Republic, Georgia, Guatemala, India, Indonesia, Jordan, Kenya, Kuwait, Lebanon, Mali, Mexico,
Morocco, Panama, Paraguay, Rwanda, Senegal, the Slovak Republic, South Africa, Sudan,
Tanzania, Thailand, Togo, Turkey, Uganda, Uruguay, Vietnam, Zambia, and Zimbabwe.
Consultations were also held at different stages of report preparation with representatives
from multilateral and bilateral partners, including the Australian Agency for International
Development (AUSAID), the Canadian International Development Agency (CIDA), the
Inter-American Commission of Women-Organization of American States (CIM-OAS), the
Danish International Development Agency (DANIDA), the U.K. Department for International
Development (DFID), the Food and Agriculture Organization (FAO), the Japan International
Cooperation Agency (JICA), the International Labour Organization (ILO), the Ministry for
Foreign Affairs of Finland, MCC, NORAD, the Organisation for Economic Co-operation

xv

xvi

AC K N OW L E D G M E N T S

and Development-Development Assistance Committee (OECD-DAC) Gendernet, the Swiss
Agency for Development and Cooperation (SDC), the Swedish International Development
Cooperation Agency (SIDA), UN Women, the United Nations Childrenâ&#x20AC;&#x2122;s Fund (UNICEF),
the United States Agency for International Development (USAID), and the United Nations
Economic and Social Council (ECOSOC) 55th Commission on the Status of Women.
The team would like to acknowledge the generous support of the Government of Norway through its Royal Ministry of Foreign Affairs, SDC, AUSAID, CIDA, the Government of
Sweden through its Ministry for Foreign Affairs, the multi-donor Knowledge for Change
Program (KCP), the Nike Foundation, the World Bank Nordic Trust Fund, and Fast Track
Initiative Education Program Development Fund; as well as the in-kind support from JICA,
DFID, and OECD.
The team wishes to acknowledge the excellent support of the WDR production team comprising Rebecca Sugui, Cecile Wodon, and Mihaela Stangu, and of the resource management
team of Sonia Joseph and Evangeline Santo Domingo. We thank also Ivar Cederholm, Vivian
Hon, Jimmy Olazo, and Irina Sergeyeva for their constant support. Other valuable assistance
was provided by Gytis Kanchas and Nacer Mohamed Megherbi. Vamsee Krishna Kanchi,
Swati P. Mishra, Merrell Tuck-Primdahl, and Roula Yazigi assisted the team with the website
and communications.
Bruce Ross-Larson was the principal editor. The Development Data Group contributed
to the data appendix and was responsible for the Selected World Development Indicators.
Design Symphony contributed to the design. The Office of the Publisher and GSDTR provided excellent publishing, translation, and dissemination services, with special thanks to
Mary Fisk, Stephen McGroarty, Nancy Lammers, Santiago Pombo-Bejarano, Denise Bergeron,
Rick Ludwick, Cecile Jannotin, Hector Hernaez, and Bouchra Belfqih for their contributions.

acquired immunodeficiency syndrome
active labor market policies
African National Congress
Asia-Pacific Economic Cooperation
antiretroviral therapy
Association of Southeast Asian Nations
automated teller machine
Australian Agency for International Development
business process outsourcing
Caribbean Community
conditional cash transfer
Convention on the Elimination of All Forms of Discrimination
against Women
Consultative Group to Assist the Poor
Canadian International Development Agency
Inter-American Commission of Women (Organization of
American States)
Corporate Women Directors International
Danish International Development Agency
Development Finance Company of Uganda
United Kingdom Department for International Development
East Asia and Pacific Region
Europe and Central Asia Region
early child development
Economic and social council (United Nations)
Education Attainment and Enrollment around the World
database
excess female mortality
European Union
European Union Statistics on Income and Living Conditions
Food and Agriculture Organization
foreign direct investment
Federação Nacional dos Trabalhadores Domésticos (National
Federation of Domestic Workers)
female genital cutting
female-headed households
Foundation for International Community Assistance
female labor force participation rate
free primary education
xvii

Sub-Saharan Africa Region
UNESCO Institute for Statistics
Joint United Nations Program on HIV/AIDS
United Nations Development Programme
United Nations Educational, Scientific and Cultural
Organization
United Nations Human Settlements Program
United Nations Childrenâ&#x20AC;&#x2122;s Fund
United Nations Development Fund for Women
United Nations Research Institute for Social Development
United Nations Entity for Gender Equality and the
Empowerment of Women
United States Agency for International Development
World Health Organization
womenâ&#x20AC;&#x2122;s international nongovernmental organizations

DATA NOTES
The countries included in regional and income groupings in this Report are listed in the
Classification of Economies table at the end of the Selected World Development Indicators.
Income classifications are based on GNP per capita; thresholds for income classifications in
this edition may be found in the Introduction to Selected World Development Indicators.
Group averages reported in the figures and tables are unweighted averages of the countries in
the group, unless noted to the contrary.
The use of the word countries to refer to economies implies no judgment by the World
Bank about the legal or other status of a territory. The term developing countries includes lowand middle-income economies and thus may include economies in transition from central
planning, as a matter of convenience. The term advanced countries may be used as a matter of
convenience to denote high-income economies.
Note: Dollar figures are current U.S. dollars, unless otherwise specified. Billion means 1,000
million; trillion means 1,000 billion.

xix

Main Messages of the
World Development Report 2012
GENDER EQUALITY MATTERS
FOR DEVELOPMENT
Gender equality is a core development objective in its own right. It is also smart economics.
Greater gender equality can enhance productivity, improve development outcomes for the
next generation, and make institutions more
representative.
• Productivity gains. Women now represent
40 percent of the global labor force, 43 percent of the world’s agricultural labor force,
and more than half the world’s university
students. Productivity will be raised if their
skills and talents are used more fully. For example, if women farmers were to have the
same access as men to fertilizers and other
inputs, maize yields would increase by almost
one-sixth in Malawi and Ghana. And eliminating barriers that discriminate against
women working in certain sectors or occupations could increase labor productivity by as
much as 25 percent in some countries.
• Improved outcomes for the next generation.
Greater control over household resources by
women can enhance countries’ growth prospects by changing spending patterns in ways
that benefit children. And improvements in
women’s education and health have been
linked to better outcomes for their children
in countries as varied as Brazil, Nepal, Pakistan, and Senegal.
• More representative decision making. Gender equality matters for society more broadly.

Empowering women as economic, political,
and social actors can change policy choices
and make institutions more representative of
a range of voices. In India, giving power to
women at the local level led to increases in
the provision of public goods, such as water
and sanitation, which mattered more to
women.

DEVELOPMENT HAS CLOSED SOME
GENDER GAPS . . .
The disadvantages faced by women and girls
that have shrunk most rapidly over the past
quarter century include:
• Educational enrollment. Gender gaps in primary education have closed in almost all
countries. In secondary education, these gaps
are closing rapidly and have reversed in many
countries, especially in Latin America, the
Caribbean, and East Asia—but it is now
boys and young men who are disadvantaged.
Among developing countries, girls now outnumber boys in secondary schools in 45
countries and there are more young women
than men in universities in 60 countries.
• Life expectancy. Since 1980, women are living longer than men in all parts of the world.
And, in low-income countries, women now
live 20 years longer on average than they did
in 1960.
• Labor force participation. Over half a billion
women have joined the world’s labor force

Main Messages of the World Development Report 2012

over the last 30 years as women’s participation in paid work has risen in most of
the developing world. An important reason has been the unprecedented reduction in fertility in developing countries
as diverse as Bangladesh, Colombia, and
the Islamic Republic of Iran.

. . . BUT OTHER GAPS PERSIST
Gender disparities still remain in many areas,
and even in rich countries. The most persistent and egregious gaps include:
• Excess deaths of girls and women. Females are more likely to die, relative to
males, in many low- and middle-income
countries than their counterparts in rich
countries. These deaths are estimated at
about 3.9 million women and girls under
the age of 60 each year. About two-fifths
of them are never born, one-sixth die in
early childhood, and over one-third die in
their reproductive years. And this number
is growing in Sub-Saharan Africa, especially in childhood and the reproductive
years and in the countries hardest hit by
the HIV/AIDS epidemic.
• Disparities in girls’ schooling. Despite
the overall progress, primary and secondary school enrollments for girls remain
much lower than for boys for disadvantaged populations in many Sub-Saharan
countries and some parts of South Asia.
• Unequal access to economic opportunities. Women are more likely than men to
work as unpaid family laborers or in the
informal sector. Women farmers tend to
farm smaller plots and less profitable
crops than men. Women entrepreneurs
operate in smaller firms and less profitable sectors. As a result, women everywhere tend to earn less than men.
• Differences in voice in households and
in society. In many countries, women—
especially poor women—have less say
over decisions and less control over resources in their households. And in most
countries, women participate less in formal politics than men and are underrepresented in its upper echelons.

UNDERSTANDING PROGRESS
AND PERSISTENCE
Income growth by itself does not deliver
greater gender equality on all fronts. Indeed,
where gender gaps have closed quickly, it is
because of how markets and institutions—
formal and informal—have functioned and
evolved, how growth has played out, and
how all these factors have interacted through
household decisions. For example, in education, income growth (by loosening budget constraints), markets (by opening new
employment opportunities for women), and
formal institutions (by expanding schools
and lowering costs) have all come together
to influence household decisions in favor of
educating girls and young women across a
broad range of countries.
Gender gaps persist where girls and women
face other disadvantages. For poor women in
poor places, sizable gender gaps remain. And
these disparities are even larger when poverty combines with other forms of exclusion,
such as remoteness, ethnicity, and disability.
For ethnic minority women in Vietnam, for
instance, more than 60 percent of childbirths
occur without prenatal care—twice as many
as for the majority Kinh women.
Markets, institutions, and households can
also combine to limit progress. Gender gaps
in productivity and earnings, for example, are pervasive. And they are driven by
deep-seated gender differences in time use
(reflecting social norms about house and
care work), in rights of ownership and control over land and assets, and in the workings
of markets and formal institutions, which
work in ways that disadvantage women.
Globalization can help. In today’s globalized
world, forces such as trade openness and the
spread of cheaper information and communication technologies have the potential
to reduce gender disparities by connecting
women to markets and economic opportunities, reshaping attitudes and norms among
women and men about gender relations,
and encouraging countries to promote gender equality. But their impact will be muted
without effective domestic public action.

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WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

PRIORITIES FOR DOMESTIC
POLICY ACTION
Policy makers in developing countries will
need to focus on those gender gaps where
the payoffs for development are potentially
the largest, higher incomes by themselves do
little to reduce these gaps, and a reorientation of policies would yield the greatest benefit. These priorities are:
• Addressing excess deaths of girls and
women and eliminating gender disadvantage in education where these remain
entrenched.
• Closing differences in access to economic
opportunities and the ensuing earnings
and productivity gaps between women
and men.
• Shrinking gender differences in voice
within households and societies.
• Limiting the reproduction of gender inequality across generations.
Focused and sustained domestic public action is essential to bring about gender
equality. And to be effective, these policies will
need to target the root causes of gender gaps.
In some areas, as with maternal mortality,
governments will need to address the single
binding constraint to progress (weak service
delivery institutions). In others, as with differential access to economic opportunities,
policies will be needed that tackle the multiple constraints that come from the workings
of markets and institutions to limit progress.
In these cases, policy makers will need to prioritize these constraints and address them
simultaneously or sequentially.
• To reduce excess deaths of girls and
women in infancy, early childhood, and
the reproductive years, policy action to
improve the delivery of services (especially
of clean water, sanitation, and maternal
care) is of primary importance. Vietnam
has been able to reduce excess mortality
among young girls by expanding access to
clean water and sanitation. And Turkey
has reduced maternal mortality through
improved health care delivery and a focus
on expectant mothers.
• To shrink persisting educational gaps,
policies need to improve access for girls

and young women when poverty, ethnicity, or geography excludes them, and to
reach boys where gender disadvantages
have reversed. Cash transfers conditioned
on school attendance are often effective in
reaching these groups. Pakistan has used
such transfers to get girls from poor families to school, while Jamaica has relied on
them to keep at-risk boys in school.
• To narrow disparities between women
and men in earnings and productivity,
a combination of policies is needed to
address the various constraints that disproportionately affect women’s access to
economic opportunities. Depending on
context, these include measures to:
Lift women’s time constraints, by providing child care as with Colombia’s
subsidized day-care programs for working mothers, and improving infrastructure as with South Africa’s rural electrification program.
Improve women’s access to productive
resources, especially to land as was done
in Ethiopia by granting joint land titles
to wives and husbands, and to credit as
in Bangladesh.
Tackle information problems and institutional biases that work against
women. These include the use of quotas or job placement programs as is being done in Jordan, or reforming gender biases in service delivery institutions
as was done for agricultural extension
through women’s self-help groups in
the Indian state of Orissa.
��� To diminish gender differences in household and societal voice, policies need to
address the combined influence of social
norms and beliefs, women’s access to economic opportunities, the legal framework,
and women’s education and skills:
To equalize voice within households,
measures that increase women’s control
over household resources and laws that
enhance the ability of women to accumulate assets, especially by strengthening their property rights, are of particular importance. Recent reforms of
family law in Morocco that equalized
the ownership rights of husbands and
wives over property acquired during
marriage are an example.

Main Messages of the World Development Report 2012

To increase women’s voice in society,

policies include quotas on political representation, as has been done by many
countries across the world, and measures to foster and train future women
leaders and involve women more in
groups such as trade unions and professional associations.
• To limit the reproduction of gender inequality across generations, it is important to reach adolescents and young adults
because this is the age when they make decisions that determine their acquisition of
skills, future health, economic prospects,
and aspirations. Interventions, therefore,
need to focus on:
Building human and social capital

as cash transfer programs have done
in Malawi, and improving information about returns to education and
health education programs, which has
kept boys in school in the Dominican
Republic;
Facilitating the transition from school

to work with job and life skills training
programs as in Uganda; and
Shifting aspirations as with exposure to

role models such as woman political
leaders in India who challenge prevailing social norms.

THE ROLE OF THE
INTERNATIONAL COMMUNITY
While domestic policy action is crucial, the
international community can play a role in

complementing these efforts in each of these
four priority areas and, more generally, in
supporting evidence-based public action
through better data, impact evaluation, and
learning.
• In some areas, as with educational gender
gaps, this will require adjusting current
support, such as ensuring that the Education for All Fast Track Initiative reaches
disadvantaged girls and boys, or sustaining existing efforts, as with partnerships
focused on adolescent girls.
• In other areas, it will demand new or
additional action on multiple fronts—
some combination of more funding, coordinated efforts to foster innovation and
learning, and more effective partnerships.
The funding should be directed partic-

ularly to supporting the poorest countries in reducing excess deaths of girls
and women (through investments in
clean water and sanitation and maternal health services) and removing persistent gender gaps in education.
More support is needed especially to
improve the availability of genderdisaggregated data and to foster more
experimentation and systematic evaluation of mechanisms to improve women’s access to markets, services, and
justice.
The partnerships should extend beyond governments and development
agencies to include the private sector,
civil society organizations, and academic institutions in developing and
rich countries.

xxiii

World Development Report 2012:
Gender Equality and Development

Overview

Baruani is reflecting on how women’s and men’s lives have changed over the past decade in
Ijuhanyondo—a village in Tanzania. “Ten years back was terrible,” she recalls. “Women were very behind. They used to be only at home doing housework. But now, they are in businesses, they are in politics.” Others hold similar views. “We do not depend a lot on men as it used to be,” says Agnetha. “We
have some cash for ourselves, and this assists us in being free from men and to some extent controlling
our lives.” In addition to managing their businesses, the women now make up half the members of the
street committee that runs the village.
Despite these positive changes, many challenges continue to weigh on women’s daily lives. Fewer than
half the homes in the village have piped water. Even more difficult, Tungise and other women of the
village still fear violence by their partners: “When they are drunk, they can begin beating up women and
children in the house. The worst bit of it is forcing sex with you.” Although legally women can inherit
land or a house, tradition prevails. “Yes, women can inherit property,” says Flora, the executive secretary
of the street committee. “In fact, in the will the father is supposed to give each son and daughter something, and nowadays the law is strict, equally. But still, men give to their sons and argue that women
have the property of where they are married.”
Dodoma Rural Community Report, from “Defining Gender in the
21st Century: Talking with Women and Men around the World:
A Multi-Country Qualitative Study of Gender and Economic Choice”
(World Bank 2011)

WHY DOES GENDER EQUALITY
MATTER FOR DEVELOPMENT?
The story of Ijuhanyondo village in Tanzania
mirrors the evolution of gender equality across
the world over the past quarter century. Although
many women continue to struggle with genderbased disadvantages in their daily lives, things
have changed for the better—and at a pace that
would have been unthinkable even two decades
ago. Women have made unprecedented gains in
rights, in education and health, and in access to
jobs and livelihoods. More countries than ever
guarantee women and men equal rights under

the law in such areas as property ownership,
inheritance, and marriage. In all, 136 countries
now have explicit guarantees for the equality of
all citizens and nondiscrimination between men
and women in their constitutions.
Progress has not come easily. And it has not
come evenly to all countries or to all women—or
across all dimensions of gender equality. The
likelihood of women dying during childbirth
in Sub-Saharan Africa and parts of South Asia
is still comparable to that in Northern Europe
in the 19th century. A wealthy urban child in
Nigeria—boy or girl—averages around 10 years
of schooling, while poor rural Hausa girls aver-

Overview

age fewer than six months. The rate at which
women die relative to men is higher in low- and
middle-income countries compared with their
high-income counterparts, especially in the critical years of infancy and early childhood and
in the reproductive period. Divorce or widowhood causes many women to become landless
and lose their assets. Women continue to cluster in sectors and occupations characterized as
“female”—many of them lower paying. Women
are also more likely to be the victims of violence
at home and suffer more severe injuries. And
almost everywhere women’s representation in
politics and in senior managerial positions in
business remains far lower than men’s.
Do these patterns of gender inequality–
in human and physical capital endowments,
in economic opportunities, and in the ability
to make choices to achieve desired outcomes
(agency)—matter, particularly those that persist even as the development process unfolds?
This World Development Report (WDR) argues that they do for two reasons. First, gender
equality matters intrinsically, because the ability to live the life of one’s own choosing and
be spared from absolute deprivation is a basic
human right and should be equal for everyone,
independent of whether one is male or female.
Second, gender equality matters instrumentally,
because greater gender equality contributes to
economic efficiency and the achievement of
other key development outcomes.

Gender equality matters in its own right
Following Amartya Sen, we see development
as a process of expanding freedoms equally for
all people.1 In this view of development, gender equality is a core objective in itself (box
1). So, just as development means less income
poverty or better access to justice, it should also
mean fewer gaps in well-being between males
and females. This viewpoint is also evident in
the international development community’s
recognition that women’s empowerment and
gender equality are development objectives in
their own right, as embodied in Millennium
Development Goals 3 and 5 (box 2). It is seen
as well in the adoption and widespread ratification of the Convention on the Elimination of
All Forms of Discrimination against Women
(CEDAW). Adopted by the United Nations
General Assembly in 1979, the convention established a comprehensive framework for the

advancement of women and has been ratified to
date by 187 countries.

Gender equality matters for
development—It is smart economics
Gender equality matters also as an instrument
for development. As this Report shows, gender
equality is smart economics: it can enhance economic efficiency and improve other development outcomes in three ways. First, removing
barriers that prevent women from having the
same access as men to education, economic opportunities, and productive inputs can generate
broad productivity gains—gains all the more
important in a more competitive and globalized
world. Second, improving women’s absolute and
relative status feeds many other development
outcomes, including those for their children.
Third, leveling the playing field—where women
and men have equal chances to become socially
and politically active, make decisions, and shape
policies—is likely to lead over time to more representative, and more inclusive, institutions and
policy choices and thus to a better development
path. Consider each in turn.
Misallocating women’s skills and talent
comes at a high (and rising) economic cost
Gender equality can have large impacts on productivity. Women now represent more than 40
percent of the global labor force, 43 percent of
the agricultural workforce, and more than half
of the world’s university students. For an economy to be functioning at its potential, women’s
skills and talents should be engaged in activities
that make the best use of those abilities. But,
as the stories of many women illustrate, this
is not always the case. When women’s labor is
underused or misallocated—because they face
discrimination in markets or societal institutions that prevents them from completing their
education, entering certain occupations, and
earning the same incomes as men—economic
losses are the result. When women farmers
lack security of land tenure, as they do in many
countries, especially in Africa, the result is lower
access to credit and inputs and to inefficient
land use, reducing yields. Discrimination in
credit markets and other gender inequalities in
access to productive inputs also make it more
difficult for female-headed firms to be as productive and profitable as male-headed ones.
And, when women are excluded from manage-

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WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

BOX 1

What do we mean by gender equality?

Gender refers to the social, behavioral, and cultural attributes,
expectations, and norms associated with being a woman or a man.
Gender equality refers to how these aspects determine how women
and men relate to each other and to the resulting differences in
power between them.
This Report focuses on three key dimensions of gender equality
identified by men and women from Afghanistan to Poland to South
Africa, as well as by researchers: the accumulation of endowments
(education, health, and physical assets); the use of those endowments to take up economic opportunities and generate incomes;
and the application of those endowments to take actions, or agency,
affecting individual and household well-being. These are aspects of
equality where shortfalls of choice are reflected in shortfalls of welfare. They matter in and of themselves. But they are also closely
interlinked.
Gender inequality is both similar to and different from inequality based on other attributes such as race or ethnicity. Three differences are of particular relevance to the analysis of gender equality.
First, the welfare of women and men living in the same household
is difficult to measure separately, a problem that is compounded by
the paucity of data on outcomes in the household. Second, preferences, needs, and constraints can differ systematically between
men and women, reflecting both biological factors and “learned”
social behaviors. Third, gender cuts across distinctions of income
and class. These characteristics raise the question whether gender
equality should be measured as equality of outcomes or equality of
opportunity. The economic and philosophical literature on this
issue is divided.
Those who defend framing gender equality as equality of opportunity argue that it allows one to distinguish between inequalities

that arise from circumstances beyond the control of individuals and
those that stem from differences in preferences and choices. A substantial body of research documents such male-female differences in
risk aversion, social preferences, and attitudes about competition. It
follows that if men and women differ, on average, in attitudes, preferences, and choices, then not all observed differences in outcomes
can be attributed to differences in opportunities.
Those who argue for equality of outcomes argue that differences in preferences and attitudes are largely “learned” and not
inherent—that is, they are the result of culture and environment
that lead men and women to internalize social norms and expectations. Persistent differences in power and status between men
and women can become internalized in aspirations, behaviors, and
preferences that perpetuate the inequalities. So, it is difficult to
define equality of opportunity without also considering how actual
outcomes are distributed. Only by attempting to equalize outcomes can one break the vicious circle of low aspirations and low
opportunity.
Despite this debate, it is difficult in practice to measure opportunities separately from outcomes. Indeed, equality of opportunities and equality of outcomes are tightly linked both in theory and
in measurement. For this reason, the Report takes a pragmatic
approach, focusing on both outcomes and opportunities in relation
to endowments, agency, and access to economic activities. Following Sen, we also believe that while people may disagree in what is
just or fair, they will agree on eliminating what are “outrageously
unjust arrangements.” In other words, while it may be difficult
to define whether gender equality is about outcomes or opportunities, most will agree that gross manifestations of gender inequality
should be eliminated.

The Millennium Development Goals recognize the intrinsic and
instrumental value of gender equality

The 2010 Millennium Development Goal (MDG) Summit concluded with the adoption of a global action
plan to achieve the eight goals by 2015. The summit
also adopted a resolution calling for action to ensure
gender parity in education and health, economic
opportunities, and decision making through gender
mainstreaming in development policy making. The
resolution and the action plan reflect the belief of the
international development community that gender

equality and women’s empowerment are development objectives in their own right (MDG 3 and 5), as
well as serving as critical channels for achieving the
other MDGs and reducing income and non-income
poverty. Gender equality and women’s empowerment help to promote universal primary education
(MDG 2), reduce under-five mortality (MDG 4),
improve maternal health (MDG 5), and reduce the
likelihood of contracting HIV/AIDS (MDG 6).

Source: WDR 2012 team.

ment positions, managers are less skilled on
average, reducing the pace of innovation and
technology adoption.2
The direct payoff to correcting these failures,
many rooted in how markets and institutions

function, is large: ensuring that women farmers
have the same access as men to fertilizer and other
agricultural inputs would increase maize yields
by 11 to 16 percent in Malawi and by 17 percent
in Ghana.3 Improving women’s property rights

Overview

in Burkina Faso would increase total household
agricultural production by about 6 percent, with
no additional resources—simply by reallocating resources (fertilizer and labor) from men to
women.4 The Food and Agriculture Organization (FAO) estimates that equalizing access to
productive resources between female and male
farmers could increase agricultural output in
developing countries by as much as 2.5 to 4 percent.5 Eliminating barriers that prevent women
from working in certain occupations or sectors
would have similar positive effects, reducing
the productivity gap between male and female
workers by one-third to one-half (chapter 5) and
increasing output per worker by 3 to 25 percent
across a range of countries.6 But achieving these
gains will not occur automatically as countries
get richer: multiple and sometimes reinforcing
barriers to gender equality can get in the way.
These productivity gains are likely to be even
larger in a more integrated world where efficiency
in the use of resources is essential to a country’s
competitiveness and growth. Indeed, recent
work shows that gender inequality has become
more costly for most countries in a world of open
trade.7 Gender inequality diminishes a country’s
ability to compete internationally—particularly
if the country specializes in exporting goods and
services for which men and women workers are
equally well suited. Industries that rely more on
female labor expand more in countries where
women are more equal.8 The relationship also
goes the other way: countries with an advantage
in making products that rely more on women’s
labor also have become more gender equal.9
And in countries and regions with rapidly aging
populations, like China and Europe and Central
Asia, encouraging women to enter and remain
in the labor force can help dampen the adverse
impact of shrinking working-age populations.
So, in a globalized world, countries that reduce
gender-based inequalities, especially in secondary and tertiary education and in economic participation, will have a clear advantage over those
that delay action (chapter 6).
Women’s endowments, agency, and
opportunities shape those of the next
generation
Greater control over household resources by
women leads to more investment in children’s
human capital, with dynamic positive effects
on economic growth. Evidence from a range

of countries (such as Bangladesh, Brazil, Côte
d’Ivoire, Mexico, South Africa, and the United
Kingdom) shows that increasing the share of
household income controlled by women, either
through their own earnings or cash transfers,
changes spending in ways that benefit children.10 In Ghana, the share of assets and the
share of land owned by women are positively
associated with higher food expenditures.11 In
Brazil, women’s own nonlabor income has a
positive impact on the height of their daughters.12 In China, increasing adult female income
by 10 percent of the average household income
increased the fraction of surviving girls by 1 percentage point and increased years of schooling
for both boys and girls. In contrast, a comparable increase in male income reduced survival
rates and educational attainment for girls, with
no impact on boys.13 In India, a woman’s higher
earned income increases her children’s years of
schooling.14
Improvements in women’s own education
and health also have positive impacts on these
and other outcomes for their children. Better
nutritional status of mothers has been associated with better child health and survival.15
And women’s education has been positively
linked to a range of health benefits for children—from higher immunization rates to better nutrition to lower child mortality. Mothers’
(and fathers’) schooling has been positively
linked to children’s educational attainment
across a broad set of countries; in Pakistan,
children whose mothers have even a single year
of education spend one extra hour studying at
home every day and report higher test scores.16
Women’s lack of agency—as seen in domestic violence—has consequences for their children’s cognitive behaviors and health as adults.
Medical research from developed countries has
established a link between exposure to domestic violence as a child and health problems as
an adult—men and women who experienced
violence in the home as children are two to
three times more likely to suffer from cancer,
a stroke, or cardiovascular problems, and five
to ten times more likely to use alcohol or illegal drugs than those who did not.17 Numerous
studies also document how experiencing violence between parents as a child is a risk factor
for women experiencing violence from their
own partners as adults, and for men perpetrating violence against their partners.18

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Increasing women’s individual and collective
agency leads to better outcomes, institutions,
and policy choices
Agency is about one’s ability to make choices—
and to transform them into desired actions and
outcomes. Across all countries and cultures,
there are differences between men’s and women’s
ability to make these choices, usually to women’s
disadvantage. These gendered differences matter for women’s well-being but also for a whole
set of outcomes for their families and for society in general. Women’s agency influences their
ability to build their human capital and take up
economic opportunities. In Bangladesh, women
with greater control over health care and household purchases have higher nutritional status.
Women’s agency also matters for the welfare of
their children. In Mexico, the daughters (but
not the sons) of women with more control
over household decisions work fewer hours on
household tasks.
Women’s collective agency can be transformative for society. It can shape the institutions,
markets, and social norms that limit their individual agency and opportunities. Empowering
women as political and social actors can change
policy choices and make institutions more representative of a range of voices. Female suffrage
in the United States led policy makers to turn
their attention to child and maternal health and
helped lower infant mortality by 8 to 15 percent.19 In India, giving power to women at the
local level (through political quotas) led to increases in the provision of public goods (both
female-preferred ones such as water and sanitation and male-preferred goods such as irrigation and schools) and reduced corruption.20
Bribes paid by men and women in villages with
a female leader were 2.7 to 3.2 percentage points
less than in villages with a male leader.21 In India
and Nepal, giving women a bigger say in managing forests significantly improved conservation outcomes.22 Women’s greater public voice
not only benefits women and children but can
also benefit men. In many rich countries, greater
female participation in economic activity has
combined with their increased representation
in political leadership to reshape social views on
balancing work and family life in general and to
pass more family-friendly labor legislation.
Conversely, when women and men do not
have equal chances to be socially and politically
active and to influence laws, politics, and policy
making, institutions and policies are more likely

to systematically favor the interests of those with
more influence. Institutional constraints and
market failures that feed gender inequalities are
less likely to be addressed and corrected, leading
to their persistence. As highlighted in the World
Development Report 2006: Equity and Development, an “inequality trap” may thus emerge,
preventing generations of women from getting
educated and taking up economic opportunities on a par with men, reducing their ability to
make informed choices and to realize their potential as individuals.23

WHAT DOES THIS REPORT DO?
This Report focuses on the economics of gender
equality and development. It uses economic theory to understand what drives differences in key
aspects of welfare between men and women—
education and health, access to economic opportunities and productive resources, and the
ability to make effective choices and take action. And it uses the same economic lens to
explore what policy interventions and broader
societal action can be taken to reduce these
gender differences and improve development
outcomes generally. The Report does not limit
itself to economic outcomes—indeed, it devotes
roughly equal attention to human endowments,
economic opportunities, and women’s agency,
signaling the importance of all three interrelated
aspects in human welfare. Nor does it ignore the
central role of social and political institutions,
whether formal or informal, in determining
gender outcomes. But in its framing of the issues
and in the evidence it brings to the case for gender equality, it draws heavily on the economic
literature on gender.
We adopt this approach for four reasons. First,
it provides valuable insights into how key gender
outcomes emerge and evolve as the development
process unfolds, as well as how the role and effectiveness of policy influence these outcomes.
Second, it builds on a tradition of World Bank
work on the economics of gender (most notably,
the Engendering Development report24) and on
the institution’s strongest areas of expertise and
specialization. Third, there are significant data
and knowledge gaps that we can help fill in this
area. Fourth, while the Report often arrives at diagnoses similar to those of other approaches, it
provides different insights into the policy levers
that can be used in support of gender equality.

Overview

The Report focuses largely on inequalities
affecting women, dwelling on ones likely to be
reproduced and passed on to the next generation. But it also focuses on inequalities affecting
men, while recognizing that most of these male
inequalities affect fewer realms of welfare.
We adopt an empirical approach, preferring rigorous and evidence-based analysis and
highlighting causality where feasible. For this,
we draw on a large and growing body of quantitative gender research, complemented by new
analysis, particularly on time use, domestic
violence, mortality risks, and inputs into agriculture and entrepreneurship. We also draw on
new qualitative field research with more than
4,000 men and women in 98 communities from
19 developing countries, exploring how gender
affects their everyday lives and their aspirations,
education, job choices, decision making, and
other aspects of well-being (box 3).25
A global report like this one cannot provide
in-depth analysis of specific country circumstances. Nor can it cover all relevant dimensions
of gender equality. Instead, it proposes a conceptual framework to explain gender inequality and recommend public action, which can
be adapted as necessary to specific countries,
issues, and sectors. It then illustrates the use of
this framework by focusing on aspects of gender equality where there has been most progress
worldwide (education, fertility, life expectancy,
labor force participation, and the extension of
legal rights) and where there has been little or
very slow change (excess female mortality, segregation in economic activity, gaps in earnings,
responsibility for house and care work, asset
ownership, and women’s agency in private and
public spheres).

“

BOX 3

How women and men define gender in the
21st century

To inform this Report the World Bank conducted new field research in 19 countries in all regions to gain a first-hand look at how men and women experience
gender in their everyday lives.
Women and men from all age groups, incomes, and locations see education, the ownership of assets, access to economic opportunities, and
opportunities to earn an income as the keys to improving their well-being and
that of their families. In 500 focus groups, researchers identified women’s and
men’s roles and responsibilities in private and public spheres—with women’s
tasks being largely associated with family care and home production, and
men’s with income generation and decision making. But differences across
generations clearly show that these roles are being redefined in a world that
offers new opportunities and demands for both men and women.
The findings also show that old problems persist in new settings even as
new challenges are emerging. Many groups face pervasive disadvantages—for
them, change remains an aspiration for future generations but not a reality in
their everyday lives.
Source: World Bank 2011.
Note: The exercise was conducted with men and women of diﬀerent age groups in 98 communities (about
4,000 individuals) in Latin America (Dominican Republic and Peru), Europe and Central Asia (Moldova, Poland, and Serbia), Africa (Burkina Faso, Liberia, Sudan, South Africa, and Tanzania), South Asia (Afghanistan,
Bhutan, and India), the Middle East (West Bank and Gaza and the Republic of Yemen), East Asia (Indonesia
and Vietnam), and the Paciﬁc Islands (Fiji and Papua New Guinea).

Drawing on past and recent work on gender
and development within the World Bank26 and
elsewhere, the Report posits that gender outcomes can be understood through the responses
of households to the functioning and structure
of markets and institutions, both formal and informal. Families decide how many children to
have and when, how much to spend on education and health for daughters and sons, how to
allocate different tasks (inside and outside the
household), and other matters that influence
gender outcomes.

I believe that a woman must be educated and must work in order to prove herself in
society and to be a better mother.
Young woman in Rafah city, West Bank and Gaza

Women should work. Why should I stay at home if I can work outside? I should
also earn income and my people and myself should enjoy the money I can make.
Those days where our mothers were to ask for money from our fathers, even for
simple things like underwear are gone: we need our own money and this means
that we should work.

”

7

Young woman in Bukoba municipality, Tanzania

8

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

BOX 4

What do we mean by markets, formal institutions,
and informal social institutions?

Markets—a variety of arrangements that allow buyers and sellers to exchange
(the rights over) any type of goods and services subject to a set of rules. Markets
allow for any item that is exchanged to be evaluated and priced. Markets can be
influenced and shaped by formal and informal institutions.
Formal institutions—all aspects that pertain to the functioning of the state,
including laws, regulatory frameworks, and mechanisms for the delivery of services that the state provides (such as judicial services, police services, basic infrastructure, health, and education).
Informal social institutions—the mechanisms, rules, and procedures that shape
social interactions but do not pertain to the functioning of the state. In this
Report, the focus is on gender roles, beliefs, social norms, and social networks.
Gender roles provide guides to normative behaviors for each sex within certain
social contexts. Roles gain power as they are learned through socialization, elaborated in cultural products, and enacted in daily life. The repeated experience of
performing gender roles affects widely shared beliefs about men’s and women’s
attributes and one’s own sense of identity. Social norms refer to patterns of
behavior that flow from socially shared beliefs and are enforced by informal social
sanctions. These can affect household bargaining in many ways: they set limits
on what can be bargained about; they can be a determinant of or constraint to
bargaining power; they can affect how bargaining is conducted; and they themselves can be subject to bargaining and can change. Social networks refer to the
system of social relationships and bonds of cooperation for mutual benefit that
shape one’s opportunities, information, social norms, and perceptions.
Sources: Agarwal 1994, 1997; Fehr, Fischbacher, and Gätcher 2002; Kabeer 1999; Sen 1990.

They make these choices on the basis of the
preferences, incentives, and constraints of different family members, and in relation to their
relative voice and bargaining power. Preferences
are shaped by gender roles, social norms, and
social networks (which we group under the label
informal institutions). Incentives are largely influenced by markets (including the markets for
labor, credit, land, and goods), which determine
the returns to household decisions and investments. Constraints arise from the interplay of
formal institutions (comprising all that pertain
to the functioning of the state) and markets but
also reflect the influence of informal institutions

“

I think women should go out as well to look
for a job because men are failing to get jobs;
for women it is easier because they have more
options.

”

Young man in rural Ngonyameni,
South Africa

(box 4). Voice and bargaining power of household members are defined by a range of factors,
including their ownership of and control over
resources, their ability to leave the household
(exit options), and social norms. In this way,
household decision making, markets, formal
institutions, and informal institutions combine
and interact to determine gender-related outcomes (figure 1).
The benefits of economic development (the
combination of higher incomes and better service delivery institutions) on gender outcomes
can be seen clearly through this framework as
emerging from the workings of households,
markets, and institutions and their interactions.
These impacts are illustrated in figure 1 by the
“growth” arrow that turns the gears in the direction of greater gender equality. The impact of
more gender equality on growth is in turn captured by the “gender equality” arrow that flows
back into higher growth.

WHERE HAS THERE BEEN THE MOST
PROGRESS IN GENDER EQUALITY?
For women and girls in developing countries,
much has changed for the better in the past
quarter century. Take female life expectancy at
birth. It increased dramatically in developing
countries (by 20 to 25 years in most regions in
the past 50 years) to reach 71 years globally in
2007 (compared with 67 for men), and women
now outlive men in every region of the world.
The changes were much faster than when today’s rich countries were poorer. It took more
than 100 years for the number of children born
to a woman in the United States to decline from
6 to 3; the same decline took just over 35 years
in India and less than 20 in Iran (figure 2). The
same patterns can be seen in primary education.
It took the United States 40 years (from 1870
until 1910) to increase enrollments among girls
aged 6 to 12 years from 57 percent to 88 percent;
Morocco achieved a similar increase for this age
group in just over a decade (from 58 percent in
1997 to 88 percent in 2008).

Girls’ education
Progress in closing gender gaps in education has
been steady and sustained at all levels—primary,
secondary, and tertiary. In many countries, and
especially for higher education, these gaps are

9

Overview

Gender outcomes result from interactions between households, markets, and institutions

number of years for the total fertility
rate to fall from more than 6 children
to less than 3

Source: www.gapminder.org

now reversing, with boys and young men at a
relative disadvantage. Two-thirds of all countries have reached gender parity in primary
education enrollments, while in over one-third,
girls significantly outnumber boys in secondary
education (figure 3). Even in regions with the
largest remaining gender gaps—South Asia and
Sub-Saharan Africa (particularly West Africa)—
there have been considerable gains. And in a
striking reversal of historical patterns, more
women than men now attend universities, with
women’s tertiary enrollment across the globe
having risen more than sevenfold since 1970
(fourfold for men). Yet while boy disadvantage
is slowly emerging in some places, girl disadvantage where it exists tends to emerge earlier in life
and is deeper.

Women’s market work
Women’s labor force participation has grown
in the past 30 years as expanding economic opportunities have drawn many female workers

ENDOWMENTS

10

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

Gender parity in enrollments at lower levels has been achieved in much of the world, but tertiary
enrollments are very low and favor women
Primary education
100

Some African
countries lag behind

school enrollment, girls, net, %

school enrollment, girls, net, %

100

80

60

40

20

girls
disadvantaged

0
0

20

40

60

80

South Asia

80

60

40

20

girls
disadvantaged

0

100

0

20

40

60

80

school enrollment, boys, net %

Europe and Central Asia

Sub-Saharan Africa

100

Enrollment gaps dwarf
gender gaps

school enrollment, boys, net %
East Asia and Pacific

Tertiary education

Secondary education

Latin America and the Caribbean

100

school enrollment, women, gross, %

FIGURE 3

men
disadvantaged

80

60

40

Women are
more likely
to participate
than men

20

0
0

20

40

60

80

100

school enrollment, men, gross %
Middle East and North Africa

High-income countries

Source: WDR 2012 team estimates based on World Development Indicators.
Note: The 45° line in each ﬁgure above shows gender parity in enrollments. Any point above the 45° line implies that more women are enrolled relative to men.

into the market. Between 1980 and 2008, the
gender gap in participation narrowed from 32
percentage points to 26 percentage points. By
2008, women represented more than 40 percent
of the global labor force. Large increases in participation in countries that started with very low
rates (mainly in Latin America and the Caribbean and to a lesser extent in the Middle East
and North Africa) combined with small declines
in countries that started with very high rates
(mainly in Eastern Europe and Central Asia)
mean that rates have converged across regions,
although significant differences remain. Female
labor force participation is lowest in the Middle East and Northern Africa (26 percent) and
South Asia (35 percent) and highest in East Asia
and the Pacific (64 percent) and Sub-Saharan
Africa (61 percent).

What explains progress?
Where gaps have closed quickly, it has been a
result of how markets and institutions have
functioned and evolved, how growth has played
out, and how all these factors have interacted
through household decisions. For education,
consider each in turn. Higher incomes allow
families that had previously only sent their sons
to school to now send their daughters as well.
As countries get richer, their economic struc-

tures change so that activities in which men
no longer have an advantage become more
prominent. This shift opens new opportunities
for women’s employment, and households respond to these signals by educating daughters.
Richer countries can also invest in more accessible education systems by building schools
and hiring teachers. When combined with better incentive and accountability systems, these
inputs help deliver better and cheaper services,
lowering the costs of access to households and
increasing their use. Where all these factors
have worked together, the gaps have closed rapidly, as in Morocco.
But even if bottlenecks appear in any one
of these channels—pro-boy preferences within
households or inadequacies in the provision of
education or slow growth or limits on women’s
employment opportunities—the other channels
still have allowed progress in educating girls. Policies targeted to getting children to school, such
as the conditional cash transfers used in more
than 30 countries worldwide (many explicitly
targeting girls, as in Bangladesh and Cambodia),
have also helped. These forces are illustrated in
figure 4 by the (green) gears representing households, formal institutions, and markets all moving in ways that narrow educational gender gaps
(“oiled” by supportive policies).

The interactions between households, markets and institutions can also explain the pattern
and pace of female labor force participation. A
woman’s decision to work outside the home responds both to changes in her own wages and
to changes in her household income. As lowincome countries grow richer, women participate less in market work because their household
incomes also rise. Over time, their education levels also increase as formal institutions respond.
Rising incomes also lead to later marriage and
childbearing and lower fertility. These factors
all bring women back into the labor force. In 10
Latin American countries, almost two-thirds of
the increase in women’s labor force participation in the past two decades can be attributed
to more education and to changes in family
formation (later marriage and lower fertility).27
These different impacts of income growth and
rising women’s wages lead to a U-shaped pattern of female labor force participation across
countries (figure 5). But notably, since 1980, the
female participation rate at each level of income

has increased sharply over time. So, at every level
of per capita income, more women are now engaged in economic activity outside the home
than ever before.
There are two main reasons why gains in
some domains of gender equality in many developing countries came faster than they did for
today’s rich countries when they were at comparable incomes. First, the incomes of many
developing countries have grown faster. Since
1950, 13 developing countries have grown at
an average of 7 percent a year for more than 25
years or longer—a pace unprecedented before
the latter half of the 20th century.28 Second, the
various domains of gender outcomes are interrelated. So, improvements in one have spurred
advances in others. The decline in fertility that
has come with higher incomes has helped lower
the number of deaths associated with maternal
mortality. And bearing fewer children has given
women more time to invest in acquiring human capital and to participate in the economy.
Forward-looking parents have responded to the

ENDOWMENTS

12

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

female labor force participation rate, %

FIGURE 5

Female labor force participation has increased over
time at all income levels

• In the four decades since Bangladesh gained
independence, the average number of children a woman will have during her lifetime
fell from almost 7 to just over 2. School enrollment among girls rose from a third in
1991 to 56 percent in 2005. And just in the
latter part of the 1990s, labor force participation for young women more than doubled.

80

2008

70

60

50

1980

40
4

6

8

10

from educating girls and from women working
become evident. Consider the notable advances
in gender equality in two very different countries: Bangladesh and Colombia.

12

log, GDP per capita (constant 2000 US$)

Source: WDR 2012 team calculations based on International Labor Organization 2010 (130 countries).

expanded employment opportunities by increasing their educational investments in their
daughters. These better educated girls are more
likely to work when they become older, have
fewer children, and exercise more voice in their
households—feeding the cycle of change. So,
the progress in fertility, the gains in education,
the gains in women’s agency, and the shifts of
women to market work are not only related but
also mutually reinforcing. Public policies have
themselves played a role, because the big push
for universal education of the past decade has
helped get all children to school.
The main lesson: when market signals, formal institutions, and income growth all come
together to support investments in women, gender equality can and does improve very quickly.
And these improvements can occur even when
informal institutions, such as social norms
about what is “appropriate” for girls and boys
or women and men, may themselves take time
to adapt. This is not to say that social norms
have not been important in determining these
outcomes. The differences across countries and
among regions within countries both in closing gender gaps in educational attainment and
levels of women’s labor force participation highlight their influence. But the fast pace of change
in education and even in labor force participation almost everywhere shows how these norms
adapt quite quickly as the economic returns

• In Colombia, the average number of children
a woman will bear dropped from 3.2 to 2.4
between the mid-1980s and 2005. Women
also reversed the education gap and now
have higher completion rates than men for
primary, secondary, and even tertiary education. And the country has the steepest increase in women’s labor force participation
in the region, giving it one of the highest participation rates in Latin America. Women
there are well represented in managerial positions and in finance—the glass ceilings notoriously hard to break through even in many
rich countries.

The problem of severely disadvantaged
populations
The combined forces of markets, service delivery institutions, and income growth that have
contributed to closing gender gaps in education,
fertility, and labor force participation for many
women have not worked for everyone. For poor
women and for women in very poor places,
sizable gender gaps remain. And these gaps are
even worse where poverty combines with other
factors of exclusion—such as ethnicity, caste,
remoteness, race, disability, or sexual orientation. Even in education, where gaps have narrowed in most countries, girls’ enrollment in
primary and secondary school has improved
little in many Sub-Saharan countries and
some parts of South Asia. School enrollments
for girls in Mali are comparable to those in
the United States in 1810, and the situation
in Ethiopia and Pakistan is not much better
(figure 6). And in many countries, gender disparities remain large only for those who are
poor. In both India and Pakistan, while boys
and girls from the top income quantile (fifth)
participate in school at similar rates, there is a

Overview

WHERE HAVE GENDER INEQUALITIES
PERSISTED AND WHY?
By contrast to areas that have seen good progress, change has come slowly or not at all for
many women and girls in many other dimensions of gender equality. Health disadvantages
that show up in the excess relative mortality of
girls and women fall into this category. So do
other persistent gender disparities, including
segregation in economic activity, gender gaps in
earnings, male-female differences in responsibil-

gender gap of almost five years in the bottom
income quantile (figure 7).
Beyond the poor, gender gaps remain particularly large for groups for whom ethnicity,
geographical distance, and other factors (such
as disability or sexual orientation) compound
gender inequality. Almost two-thirds of out-ofschool girls globally belong to ethnic minority
groups in their own countries.29 The illiteracy
rate among indigenous women in Guatemala
stands at 60 percent, 20 points above indigenous men and twice the rate of nonindigenous
women.30
For these severely disadvantaged groups—
which can be pockets of disadvantage or entire swaths of countries or regions—none of
the forces that favor educating girls and young
women are working. So, the growth in aggregate
income may not be broad-based enough to benefit poor households. Market signals are muted
because economic opportunities for women do
not expand much or because other barriers—
such as exclusion caused by ethnicity, race, or
caste—get in the way of accessing those opportunities. And service delivery is often riddled
with problems because poverty, distance, and
discrimination mean that these groups do not
see an expansion of schools and teachers. This
does not mean that the channels that have favored girls’ education elsewhere will not work
for these groups. It means that efforts need to
be redoubled to ensure that the essential building blocks for progress (broad-based income
growth, expanding employment opportunities
for women, and effective service delivery) are
in place. And these efforts may need to be combined with complementary interventions that
address specific disadvantages that compound
gender inequality (chapter 7).

year
United States
trend line (United States, 1850–2000)
Source: WDR 2012 team estimates based on U.S. Census and the International Income Distribution
Database (I2D2).
Note: Values between 1760 and 1840 are based on female school enrollment trending between 1850
and 2000.

ity for house and care work, gaps in asset ownership, and constraints to women’s agency in both
the private and public spheres. Progress in these
domains is difficult to see, despite greater prosperity in many parts of the world. Indeed, many
of these gender disparities remain salient even
among the richest countries.
Gender disparities persist in these “sticky”
domains for three main reasons. First, there
may only be a single institutional or policy
“fix,” which can be difficult and easily blocked.
We illustrate this problem with excess female
mortality. Second, disparities persist when multiple reinforcing constraints combine to block
progress. We use disparities in the economic
sphere (the persistence of gender earnings gaps
and gender segregation in employment) and in
agency (differences in societal voice and household decision making) to illustrate this problem. Third, gender differences are particularly
persistent when rooted in deeply entrenched
gender roles and social norms—such as those

13

14

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

FIGURE 7

Female disadvantage within countries is more marked at low incomes
Benin

Congo, Dem. Rep.
10
median grade attained,
ages 15–19

5

0

5

0
1

2

3

4

5

2

3

4

5

1

India

Pakistan

0
3

4

5

5

Togo

5

0

income quintile

4

10
median grade attained,
ages 15–19

median grade attained,
ages 15–19

5

3

income quintile

10

2

2

income quintile

10

1

5

0
1

income quintile

median grade attained,
ages 15–19

The Gambia

10
median grade attained,
ages 15–19

median grade attained,
ages 15–19

10

5

0
1

2

3

4

5

income quintile
girls

1

2

3

4

5

income quintile
boys

Source: WDR 2012 team estimates based on EdAttain.

about who is responsible for care and housework in the home, and what is “acceptable” for
women and men to study, do, and aspire to.
And these gaps tend to be reproduced across
generations. Consider each in turn.

Higher mortality of girls and women
The rate at which girls and women die relative to
men is higher in low- and middle-income countries than in high-income countries. To quantify
this excess female mortality (“missing” girls and
women) and identify the ages at which it occurs,
this Report estimated the number of excess female deaths at every age and for every country
in 1990, 2000, and 2008.31 Excess female deaths
in a given year represent women who would not
have died in the previous year if they had lived
in a high-income country, after accounting for
the overall health environment of the country
they live in. Globally, excess female mortality
after birth and “missing” girls at birth account
every year for an estimated 3.9 million women

below the age of 60. About two-fifths of them
are never born, one-fifth goes missing in infancy
and childhood, and the remaining two-fifths do
so between the ages of 15 and 59 (table 1).
Growth does not make the problem disappear. Between 1990 and 2008, the number of
missing girls at birth and excess female mortality after birth did not change much; declines in
infancy and childhood were offset by dramatic
increases in Sub-Saharan Africa in the reproductive ages. Part of the increase is because
populations increased. But, unlike Asia, where
the population-adjusted missing women fell
in every country (dramatically in Bangladesh,
Indonesia, and Vietnam), most Sub-Saharan
countries saw little change in the new millennium. And in the countries hardest hit by the
HIV/AIDS epidemic, things got much worse.
The Report’s analysis helps explain these
patterns. Depending on the period in the life
cycle, girls and women are missing for different reasons. Missing girls at birth reflect

15

Overview

TA B L E 1

Almost 4 million missing women each year
Excess female deaths in the world, by age and region, 1990 and 2008
(thousands)

Total
women
girls at birth

girls under 5

girls 5–14

2008

1990

1990

2008

1990

2008

1990

2008

890

1,092

259

71

21

5

208

56

92

30

1,470

1,254

India

265

257

428

251

94

45

388

228

81

75

1,255

856

42

53

183

203

61

77

302

751

50

99

639

1,182

High HIV-prevalence countries

0

0

6

39

5

18

38

328

4

31

53

416

Low HIV-prevalence countries

42

53

177

163

57

59

264

423

46

68

586

766

South Asia (excluding India)

0

1

99

72

32

20

176

161

37

51

346

305

East Asia and Pacific (excluding China)

3

4

14

7

14

9

137

113

48

46

216

179

Middle East and North Africa

5

6

13

7

4

1

43

24

15

15

80

52

Europe and Central Asia

7

14

3

1

0

0

12

4

4

3

27

23

Total

2008

under 60

1990

Latin America and the Caribbean

1990

women 50–59

China

Sub-Saharan Africa

2008

women 15–49

0

0

11

5

3

1

20

10

17

17

51

33

1,212

1,427

1,010

617

230

158

1,286

1,347

343

334

4,082

3,882

Source: WDR 2012 team estimates based on data from the World Health Organization 2010 and United Nations Department of Economic and Social Aﬀairs 2009.
Note: Totals do not necessarily add up due to rounding.

overt discrimination in the household, resulting from the combination of strong preferences
for sons combined with declining fertility and
the spread of technologies that allow parents to
know the sex before birth.32 This is a particular
issue in China and North India (although now
spreading to other parts of India), but it is also
visible in parts of the Caucasus and the Western
Balkans.
Missing girls during infancy and early childhood cannot be explained by a preference for
sons alone, although discrimination against girls
may contribute to it. It is a result not so much of
discrimination as of poor institutions that force
households to choose among many bad options,
particularly regarding water and sanitation.
Markets and households cannot compensate for
these poor services.
Missing women in the reproductive ages reflect two main factors. First, stubbornly high
rates of maternal mortality persist, especially in
much of Sub-Saharan Africa and some parts of

South Asia. High maternal mortality is the main
contributor to excess female mortality in the reproductive years. In Afghanistan, Chad, GuineaBissau, Liberia, Mali, Niger, Sierra Leone, and
Somalia, at least 1 of every 25 women will die
from complications of childbirth or pregnancy.
And a much larger fraction will suffer long-term
health consequences from giving birth.33
Progress in reducing maternal mortality has
not been commensurate with income growth.
In India, despite stellar economic growth in recent years, maternal mortality is almost six times
the rate in Sri Lanka. In the past two decades,
only 90 countries experienced a decline of 40
percent or more in the maternal mortality ratio, while 23 countries showed an increase. The
main problem is, again, that households are being asked to make many decisions in the face of
bad options—a result of multiple service delivery failures. In many parts of the world, this situation is reinforced by social norms that influence household behavior and make it difficult

16

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

for women to get maternal health care quickly
enough even where it is available. And high fertility, partly reflecting low incomes, compounds
the problem in parts of Sub-Saharan Africa.
Second, the impacts of the HIV/AIDS pandemic on the mortality of women in many Eastern and Southern African countries have been
dramatic. The reason for the greater prevalence
of HIV/AIDS among women relative to men is
their greater susceptibility and the greater likelihood that their sexual partners are older and
thus more likely than younger men to have HIV.
In addition, countries that have had a low-lying
civil conflict (such as Democratic Republic of
Congo) have also seen an increase in the number of “missing” women. This is in contrast to
other countries that have had outright wars—
like Eritrea, where men who went “missing” in
the years of war increased.
An examination of the historical experience
of northern and western European countries
and the United States reveals that similar patterns of excess female mortality in infancy and
the reproductive years existed there but disappeared between 1900 and 1950. These reductions
occurred primarily because of improvements

FIGURE 8

Women and men work in different sectors
distribution of female / male employment across sectors

31%

Communication Services

16%

21%

Retail, Hotels, and Restaurants

17%

13%

Manufacturing

12%

4%

Finance and Business

4%

0.5%

Electricity, Gas and Steam, and Water

1%

0.5%

Mining

2%

Transport and Telecommunications

7%

2%
27%
1%
100%

Agriculture, Hunting, etc.

29%

Construction

11%

All Sectors / All Occupations

100%

Source: WDR 2012 team estimates based on International Labour Organization 2010 (77 countries).
Note: Totals do not necessarily add due to rounding.

in the quality of institutions—in the provision of clean water, sanitation, and maternal
health care. Because there is only a single point
of entry—through better institutions—for addressing female mortality, solving the problem is
hard—much harder than getting girls to school.
But for any basic notions of human justice, the
global development community must make addressing this problem a priority.

Gender segregation in economic activity
and earnings gaps
Although women have entered the labor force
in large numbers across much of the developing
world in the past quarter century, this increased
participation has not translated into equal employment opportunities or equal earnings for
men and women. Women and men tend to
work in very different parts of the “economic
space,” with little change over time, even in
high-income countries. In almost all countries,
women are more likely than men to engage in
low-productivity activities. They are also more
likely to be in wage or unpaid family employment or work in the informal wage sector. In
agriculture, especially in Africa, women operate
smaller plots of land and farm less remunerative
crops. As entrepreneurs, they tend to manage
smaller firms and concentrate in less-profitable
sectors. And in formal employment, they concentrate in “female” occupations and sectors
(figure 8). These patterns of gender segregation
in economic activity change with economic development but do not disappear.
As a result of these differences in where
women and men work, gender gaps in earnings and productivity persist across all forms of
economic activity—in agriculture, in wage employment, and in entrepreneurship (map 1). In
almost all countries, women in manufacturing
earn less than men. In agriculture, farms operated by women on average have lower yields
than those operated by men, even for men and
women in the same households and for men
and women cultivating the same crops.34 Female entrepreneurs are also less productive than
male entrepreneurs.35 In urban areas in Eastern
Europe and Central Asia, Latin America, and
Sub-Saharan Africa, the value added per worker
is lower in firms managed by women than in
those managed by men.36 For firms operating in
rural Bangladesh, Ethiopia, Indonesia, and Sri

Overview

MAP 1

17

Earnings gaps between women and men (female earnings relative to $1 of male earnings)
Germany 62¢

Iceland 69¢

Georgia 60¢

India 64¢
A.R. of Egypt 82¢

Bangladesh 12¢

Mexico 80¢
Benin 80¢
Nigeria 60¢

Ethiopia 34¢

Sri Lanka 50¢

Malawi 90¢

Salaried Workers

Farmers

Entrepreneurs

Sources: Data for Benin come from Kinkingninhoun-Mêdagbé and others 2010; for Malawi from Gilbert, Sakala, and Benson 2002; for Nigeria from Oladeebo and Fajuyigbe 2007; for
Bangladesh, Ethiopia, and Sri Lanka from Costa and Rijkers 2011; and for Egypt, Georgia, Germany, Iceland, India, and Mexico from LABORSTA, International Labour Organization.

Lanka, the differences in profitability are significant between female-owned and male-owned
businesses.37
So, what explains this persistent gender segregation in economic activity and the resulting
gaps in earnings? The Report argues that gender
differences in time use, in access to assets and
credit, and in treatment by markets and formal
institutions (including the legal and regulatory framework) all play a role in constraining
women’s opportunities. These constraints are
shown in figure 9 as wedges blocking progress
toward greater gender equality. Income growth
has some influence in shifting these patterns but
does not eliminate them. The mutually reinforcing interactions between these different factors
make the problem particularly difficult to break.
Consider each in turn.
The differing amounts of time that men and
women allocate to care and related household
work are one factor driving segregation and
the consequent earnings gaps. In most countries, irrespective of income, women bear a

disproportionate responsibility for housework
and care, while men are responsible mostly for
market work (figure 10). When all activities are
added up, women typically work more hours
than men, with consequences for their leisure
and well-being. And everywhere they devote
more time each day to care and housework
than their male partners: differences range
from one to three hours more for housework,
two to ten times the time for care (of children,
elderly, and the sick), and one to four hours
less for market activities. Even as women take
up a bigger share of market work, they remain
largely responsible for care and housework.
And these patterns are only accentuated after
marriage and childbearing.
A second factor driving segregation in employment and earnings gaps is differences in
human and physical endowments (including
access to assets and credit). Despite increases in
women’s education, there are still differences in
human capital between women and men. These
include a gap in years of schooling among older

cohorts as well as differences in what women
and men choose to study in younger cohorts—
differences that affect employment segregation,
especially in countries where most young people
go to college. In agriculture and entrepreneurship, large and significant gender disparities in
access to inputs (including land and credit) and
in asset ownership are at the root of the gender
productivity gap. Indeed, yield differences for
female and male farmers disappear altogether
when access to productive inputs is taken into
account (figure 11). Differences in access to inputs may be further compounded by differences
in the availability of “market time,” as noted
above, which can make the same investment
less productive for women than for men. Jointly,
these constraints mean that women entrepreneurs and farmers are often restricted to businesses and activities that are less profitable and
less likely to expand.
How big are gender differences in access to
assets (especially land), credit, and other inputs? A variety of data sources suggests they are

large. Data for 16 countries in five developing
regions indicate female-headed households are
less likely to own and less likely to farm land.38
More generally, where evidence is available
for all farmers, women seldom own the land
they farm. For example, in Brazil, women own
as little as 11 percent of land. And their landholdings are systematically smaller than those
owned by men. In Kenya, women account for 5
percent of registered landholders nationally.39
And in Ghana, the mean value of men’s landholdings is three times that of women’s landholdings.40 Similarly large gaps are observed in
use of fertilizers and improved seed varieties in
agriculture, and in access to and use of credit
among entrepreneurs.
Third, market failures and institutional constraints also play a role. Labor markets often do
not work well for women, especially if their presence is limited in some sectors or occupations.
When few women are employed, employers may
hold discriminatory beliefs about women’s productivity or suitability as workers—these beliefs

Overview

FIGURE 10

Across the world, women spend more hours per day on care and
housework than men
FOR SALE

Market activities

Housework

Child care

Pakistan
0.6

4.7

5.5

2.5

1.2

0.2

2.7

3.8

4.4

3.3

0.9

0.1

2.1

3.8

4.2

1.8

0.5

0.0

2.9

3.9

4.7

2.6

0.4

0.1

3.2

4.6

3.2

2.3

0.6

0.3

2.1

4.8

4.9

1.4

0.6

0.2

Cambodia

South Africa

Bulgaria

Sweden

Italy

women

= 12 hours

men
Source: Berniell and Sanchez-PĂĄramo 2011.

can persist if there are no mechanisms in place
to correct them. Access to information about
jobs, and support for promotions and advancement, often occur in gendered networks, hurting women trying to enter a male-dominated
field (or equally hurting men trying to enter a
female-dominated one, such as nursing). And
sometimes, legal barriers, framed as protective

measures, prevent women from entering some
sectors or occupations.
In sum, whether women are farmers, entrepreneurs, or workers, many are caught in a
productivity trap: working hard on an uneven
playing field with unequal access to productive
inputs. This trap imposes significant costs on
womenâ&#x20AC;&#x2122;s welfare and economic opportunities

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FIGURE 11

Gender differences in agricultural productivity
disappear when access to and use of productive
inputs are taken into account

–13.5%

Malawi (National)

0.6%

–40%

Nigeria (Osun State)

0%
–21%

Benin (Central)

this difference disappears when women
and men have equal access to inputs

In Malawi, women’s agricultural
productivity is 13.5% lower than men’s

Less voice in societal and household
decision making
In much of the world, women have less input
than men in decision making in their households, in their communities, and in their societies. Consider women’s underrepresentation in
formal politics, especially in its upper reaches.
Fewer than one-fifth of all cabinet positions is
held by women. And women’s lack of representation extends to the judiciary and labor unions.
These patterns do not change much as countries
get richer. The share of women parliamentarians increased only from 10 percent to 17 percent
between 1995 and 2009.
Whether and how much voice a woman has
in household decision making over patterns of
spending, including spending on children, are
important markers of her agency. As many as a
third of married women in Malawi and a fifth

of married women in India are not involved in
spending decisions, even about their own incomes. Even in an upper-middle-income country like Turkey, more than a quarter of married
women in the lowest income quantile lack control over their earned income.41 Women’s ability
to own, control, and dispose of property still differs from that of men—sometimes legally, often
in practice. And again, these patterns change
only slowly as countries grow richer.
A clear manifestation of the lack of agency
is domestic violence. Violence is the opposite
of freedom—an extreme form of coercion that
by definition negates agency. Women are at far
greater risk of violence by an intimate partner or
someone they know than from violence by other
people. And women are more likely than men to
be killed, seriously injured, or victims of sexual
violence by intimate partners.42 The prevalence
of domestic violence varies greatly across countries, with no clear relationship to incomes;
while incidence tends to rise with socioeconomic
deprivation, violence knows no boundaries. In
some middle-income nations, such as Brazil
(Sao Paolo and Pernambuco region) and Serbia
(Belgrade), women report that the incidence
of physical violence by intimate partners is as
high as 25 percent.43 In Peru (Cusco), almost 50
percent of women are victims of severe physical
violence during their lifetime, and in Ethiopia
(Butajira), 54 percent of women reported being
subject to physical or sexual abuse by an intimate partner in the past 12 months. 44
Multiple factors are at work behind these
large gaps in women’s voice. In society, low
representation can be self-perpetuating, with
women unable to convey their ability to lead.
So, in politics, voters will not be able to judge
accurately the capacity of a woman leader. And
women’s entry may be limited by societal beliefs
that being engaged in politics is a masculine
activity or that women are less effective leaders
than men—beliefs that are hard to break until
a critical mass of women rises to political leadership. Different responsibilities for care work
also mean that women lack the flexibility or the
time to invest as heavily as men in participating
in political institutions. The lack of networks for
women also makes it more difficult for them to
ascend to positions of authority in political parties or labor unions.
In the household, two important determinants of a woman’s voice are her income and

Overview

her control over household assets. Economic
growth can improve the material conditions for
exercising agency, with women generally having
more voice in wealthier households. But higher
household incomes alone are not enough to
eliminate the lower capacity of women to exercise agency. What matters are a woman’s own
income and assets as well as her ability to leave
the household, all of which increase her bargaining power and ability to influence household
choices. In India, owning property substantially
enhances women’s voice in the household on
various matters and reduces her risk of domestic violence.45 Similarly, as women’s shares in
household earnings increase in Colombia and
South Africa, so does their control over key
household decisions. There is also evidence of a
relationship between women’s assets, earnings,
and shares of household income, and the incidence of domestic violence.46
But if women’s earnings are limited by malfunctioning markets or other gender-differentiated barriers to economic opportunities and asset ownership, women’s voice in the household
will remain muted. Reinforcing these market
and legal influences are social norms dictating
that men, not women, make the major decisions
in households.

Reproducing gender inequality across
generations
Perhaps the “stickiest” aspect of gender outcomes is the way patterns of gender inequality are reproduced over time. Part of this
persistence is rooted in slow-moving social
norms and how they affect what happens in
the household. Women and men internalize
social norms and expectations in ways that affect not only their own aspirations, behaviors,
and preferences but also those of their children. The Young Lives study looked at educational aspirations and noncognitive skills of
boys and girls at ages 8, 12, and 15 for 12,000
children in Ethiopia, Andhra Pradesh in India,
Peru, and Vietnam.47 Parental aspirations for
the education of their children were biased toward boys in Ethiopia and India by the age of
12 and toward girls in Peru and Vietnam. By
the age of 15, these biases had been transmitted to children, with clearly higher educational
aspirations among boys in Ethiopia and India,
and among girls in Vietnam. And by age 15,
measures of agency or efficacy showed a strong

pro-male bias in India and Ethiopia but not in
Peru and Vietnam.
A growing body of research also suggests that
attitudes about women in the family and the
workplace are transmitted across generations.
When women do not work outside the home,
their daughters are also less likely to do so as
adults, and their sons are less likely to marry
women who work outside the home.48 Young
men and young women also tend to study in
very different fields—with women favoring
education and the humanities, while men favor engineering, agriculture, and sciences—in
ways that are unrelated to abilities (chapter 3)
yet repeat themselves over generations and do
not go away as incomes rise. Evidence also suggests that domestic violence witnessed as a child
is repeated in adulthood.49 Women in Haiti who
had witnessed domestic violence were more
likely to report being the victims of physical or
sexual violence.50 The pattern is similar in Cambodia and Mexico. 51 And men in South Africa
who reported witnessing violence between their
parents were significantly more likely to report
perpetrating physical violence themselves.52
Norms may be learned in the household, but
they are often reinforced by market signals and
institutions, which are gender biased in many
aspects. For example, gender differences in the
responsibility for house and care work, as just
discussed, are rooted in gender roles but strengthened by discrimination in labor markets and by
a lack of child-care services. At the root of gendered patterns of what men and women study is
a combination of factors that feed into household
decisions (norms about what is appropriate for
girls and boys), institutions (gendered education
systems), and markets (gendered networks and
occupational segregation). For domestic violence,
empirical work finds significant explanatory
power at the individual, household, and community levels, reinforced by social perceptions and
institutional failures (including a lack of protective laws and services or their poor enforcement
and delivery).53

What can we learn from the persistence
of all these gender gaps?
Markets and institutions (formal and informal)
can work against greater gender equality—
in ways that are often mutually reinforcing.
Sometimes service delivery institutions fail, as
for young girls and women during childbirth.

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Other times markets do not work well, with
results that are worse for women, as illustrated
by evidence of discrimination in both labor and
credit markets. Often reinforcing these market failures, however, are formal institutions
that treat women and men differently. Laws
and regulations can constrain women’s agency
and opportunities more than those of men, as
when women and men have different ownership rights, or when restrictions are placed on
hours and sectors of work for women but not
for men. Where credit and labor markets already
discriminate, such unequal laws and regulations
can accentuate the problem. Unequal treatment
may also manifest itself more indirectly through
biased service delivery, as is the case for agriculture extension services. Here, institutional bias
and market structure (with women underrepresented in nonfood crops that are often the target
of extension services) reinforce and even deepen
inequalities.
All institutions (formal and informal) have
considerable inertia. They tend to reflect the interests of those who wield more power and influence, and they are difficult to change without
some form of collective agency or voice.54 Social
norms can be especially slow to change: norms
that may have served a purpose at one point in
time, but are no longer useful, may endure simply because of custom or because a social penalty is associated with being the first to break the
norm, or because the norm benefits a dominant
group in society (in this case, men). The norm’s
persistence can perpetuate gender inequalities
long after its original rationale has disappeared.
In sum, gender-differentiated market failures, institutional constraints, and persistent
social norms often combine to reinforce gender
inequalities and make improving gender equality much more complex. When there are multiple constraints, they all need to be addressed.

WHAT IS TO BE DONE?
Nothing is automatic about the growth and
development process that delivers greater gender equality on all fronts. Part of the reason is
that higher incomes and better delivery of services by the state help reduce gender gaps only
in some domains. And even in these domains,
the improvements do not reach all women. In

other domains of gender equality, such as occupational segregation and many manifestations
of women’s agency, income growth and better
service delivery are far less effective in unlocking
the often multiple and reinforcing constraints
that underlie persistent gender gaps.
The new forces of globalization can reduce
many of these gaps. First, trade openness and
the diffusion of new information and communication technologies have translated into
more jobs and stronger connections to markets
for women, increasing their access to economic
opportunities and contributing to their economic empowerment. Second, urbanization
and greater access to information have allowed
many in developing countries to learn about life
and mores in other parts of the world, including
the role of women, possibly affecting attitudes
and behaviors. Third, the incentives for public
action for gender equality are stronger than ever
because the rising global consensus on the intrinsic importance of women’s economic, social,
and political empowerment means that gender inequality hurts a country’s international
standing. But this potential of globalization
will not be realized without effective domestic
public action to close remaining gender gaps in
endowments, agency, and access to economic
opportunities.
So, what should governments in developing
countries do to foster greater gender equality?
What areas of gender inequality should they
focus on? Should they start with interventions
in education and health, or should they focus
on access to economic opportunities or agency?
What combination of policies should they implement, and in what sequence? At first blush,
these questions can appear overwhelming because of the multiplicity of priority areas and
the number of available policy instruments.
This Report shows how better analysis can help
reduce the complexity of policy choice and design in several ways.
The starting point is to determine which aspects of gender inequality should be of highest
priority for policy going forward. Three criteria
matter in this regard:
• First, which gender gaps are most significant
for enhancing welfare and sustaining development? So, where are the likely payoffs for
development from addressing gender disparities likely to be the largest?

Overview

• Second, which of these gaps persist even as
countries get richer? So, where do higher
incomes by themselves do little to reduce
disparities?
• Third, for which of these priority areas has
there been insufficient or misplaced attention? So, where would a reorientation of policies yield the greatest benefits?
Applying these criteria, we conclude that four
areas should be of the highest priority for policy
makers:
• Reducing gender gaps in human capital endowments (addressing excess female mortality and eliminating pockets of gender disadvantage in education where they persist)
• Closing earnings and productivity gaps between women and men
• Shrinking gender differences in voice
• Limiting the reproduction of gender inequality
over time, whether it is through endowments,
economic opportunities, or agency
Obviously, not all these priorities apply to all
countries. And specific country characteristics
will dictate how corrective policies will need to
be customized.
Our analysis also emphasizes that, in choosing and designing policies, it is necessary to target the determinants of the gender gaps of concern, not the outcomes. The framework in Part
2 of the Report helps highlight these underlying
causes, and shows how they emerge from the
workings of markets and institutions and their
interactions with each other and with households. In other words, the framework identifies
what problem needs to be solved and whether
interventions should target markets, formal institutions, informal institutions, or some combination of the three.
Having identified the underlying causes of
the gender gap of concern, the Report draws on
the experience with policy interventions across
a broad range of countries to provide guidance on specific interventions that could work
in different settings. It also looks at the political
economy of reforms and emphasizes that policy
design and implementation must be attuned
to countries’ institutional, social, political, and
cultural environments and to the societal actors
involved.

Policies to reduce gender gaps in
human capital endowments
(health and education)
Addressing gender gaps in human capital endowments—excess female mortality at specific
periods of the life cycle and pockets of gender
disadvantage in education—requires fixing the
institutions that deliver public services. Providing
basic services in a timely manner to expectant
mothers and improving the availability of clean
water and sanitation to households will go a long
way to closing the gender gaps in excess mortality. Education services need to focus on improving access for the significant population groups
that are currently disadvantaged by poverty, ethnicity, caste, race, or geography. Such a focus will
help address the “gender inequality traps” that
affect the poor and excluded in society.
These solutions can come from either the
demand or the supply side, but they cannot be
gender blind. On the contrary, they must factor
in explicitly, both for design and implementation, the drivers of gender inequality that cause
the gender gaps in health and education outcomes to persist. And they must bring into the
process of policy design and implementation
the voices of those that the policy is trying to
reach—excluded women and girls, and the men
and boys who live with them.
Reducing excess female mortality
The main determinants of excess female mortality in different periods of the life cycle have
little to do with how quickly countries grow.
They result from household preferences and
from failures in the ways that markets and institutions function. The entry points for policy
are dictated by which of these influences is most
binding in each period.
Skewed sex ratios at birth is a problem in a
few parts of the world, including China, parts of
India, and parts of the Caucasus and the Western
Balkans. The underlying cause is son preference
among households, which has been exacerbated
in some of these places by rapid income growth.
Higher incomes have increased access to ultrasound technologies that assist in sex selection at
birth. So, policies need to work on two fronts.
First, laws need to be enacted and enforced to
deal with the abuse of sex selection technologies, as
has been done in China and India. But experience shows that enforcement is difficult, if not

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impossible, to achieve without imposing draconian restrictions that are not feasible in most
societies and that raise other ethical concerns.
And the difficulty in enforcing such restrictions
is exacerbated because these problems are worse
among the wealthy in these societies.
A second, and more promising, approach is
to enhance household perceptions of the value of
daughters. Expanding economic opportunities
for young women, including those in the labor
market, is one way of doing this, and it can work
in conjunction with the process of development to reverse son preference. Just look at the
Republic of Korea, one of the few cases where
excess female mortality at birth was reversed in
a short period.55 And the process can be complemented by providing financial incentives to parents to have daughters (such as the “Apni Beti
Apni Dhan” program in some Indian states) and
supporting media campaigns to change societal
ideas about gender equality.
In infancy and early childhood, excess
mortality of girls is not rooted in households
or markets—although both can worsen it. It
is rooted in the failure of institutions to provide clean water, sanitation, waste disposal, and
drainage. Countries with high female mortality
in infancy are those where the burden of infectious diseases remains high. Today’s rich countries eliminated their excess female mortality of
young girls by improving access to clean water
and sanitation in the early part of the 20th century. And developing countries that have experienced large drops in excess girl mortality
during the past two decades, like Bangladesh,
China, and Vietnam, have done the same. So,
for the “missing” girls in Sub-Saharan Africa
to “reappear,” countries must invest in similar
systems and provide adequate water, sanitation, and waste disposal services to their whole
population and not just to the better-off. While
these services will benefit all young children,
young girls will benefit more due to the reduction in infectious diseases.
How exactly should countries do this? If the
experience of today’s rich countries is a guide,
part of the solution is to provide clean water at
the point of use through piped delivery. Other solutions, like water treatment at the source, are
less effective in reducing diarrhea morbidity
because of the potential for recontamination.56
The problem is then to design an institutional
framework that expands access to clean water

efficiently while ensuring that services remain
accessible and affordable for poor people.
The solution will depend on the setting, but a
few elements are critical.
• Appropriate regulations that recognize the
rationale for government intervention.
• An adequate structure of incentives for providers to make them more accountable to
policy makers.
• Measures to strengthen accountability of
both providers and policy makers to service
users.
In urban areas, providing clean water will
require an emphasis on improving the structure of contracts and, in some circumstances,
greater involvement of the private sector. In
Manila, such reforms yielded large impacts: water supply coverage expanded from 67 percent
in 1997 to 99 percent in 2009 and brought efficiency gains through lower water losses and
operating costs. In low-income settings, where
financing options and the capacity of public institutions may be more limited, charging small
amounts for services, relying on independent
providers, and finding ways of making providers more accountable to users can help, even in
smaller urban areas—this was the path followed
by Cambodia. In rural areas, local governments
can improve community systems, as Uganda has
done by collecting an additional small tax and
placing it in a fund administered by the district
council to pay for major water repairs.
For sanitation in urban settings, there usually is enough demand for improvements so
long as individuals and communities can capture the benefits of investing in the facilities. So,
the solution is to strengthen property rights and
recognize informal settlements, thus stimulating
demand while ensuring that communities have
access to independent providers. In rural areas
and less dense urban settings, the priority for
improving sanitation is to change behavior, raise
awareness, and boost demand, through community peer pressure and information campaigns
as in some communities in Cambodia, Indonesia, and Vietnam by appealing to people’s sense
of community responsibility.
Increasing the coverage of piped water and
sanitation is expensive, so significant funding—
likely external—will be needed in poor countries. A recent analysis of infrastructure funding

Overview

needs for Sub-Saharan Africa concluded that
additional spending on clean water and sanitation would need to be about one and a half
times current levels—over $11 billion annually—to improve access significantly.57 However, as documented in chapter 3, the return to
these investments taking account of mortality
declines is very large.
In the reproductive years, maternal mortality remains especially high in Sub-Saharan Africa and parts of Asia. The main reason is a failure of the institutions that deliver medical care
and services to expectant mothers. While norms
that delay women from getting prompt medical help during childbirth and high fertility may
be contributing factors in some places, solving
the problem, as with providing clean water and
sanitation, requires fixing the institutions that
deliver these services.
This fix will require providing more resources
to frontline service providers and ensuring that the
entire system of maternal care works:
First, the quality of the people in delivering the chain of services needs to be upgraded.
While additional health workers, especially
skilled birth attendants, will be a continuing
need, coverage can be increased in underserved
areas by drawing in community-level providers
and the private sector.
Second, those providing maternal health services have to be more responsive to expectant
mothers. One way is to make service providers
more accountable to them. Getting information
to users—for example, on service standards,
quality of services and policies to improve
them—can help but needs to be combined with
some way for users to act on that information.
In Uganda, community-based monitoring improved both the quality and quantity of primary
health care services.58 Another route to accountability is to ensure that citizens are able to hold
their political representatives responsible for the
failures; the politicians, in turn, need to exercise
more effective control over the service providers. The power of this mechanism is evident in
Peru, where improving maternal health required
extending coverage, giving the right incentives
to service providers, and having citizens’ voices
loud enough to be heard by policy makers.59
Professional attention for deliveries rose from 58
percent of births in 2000 to 71 percent in 2004.
Third, the financial constraints that poor
women face in accessing maternal health ser-

vices need special attention. One way to help is
to provide poor women with cash transfers conditional on their seeking maternal care. An example is India’s Janani Suraksha Yojana, where
such transfers increased the uptake of assisted
deliveries in the presence of a skilled attendant
by around 36 percent.60
Fourth, efforts to reduce maternal mortality
need to go beyond improving health systems
and services and work across sectors. The successes of Malaysia and Sri Lanka in addressing
maternal mortality early in their development
illustrate this point (box 5). Fairly small investments in infrastructure (rural roads) and in
women’s education, combined with training
maternal health providers and building hospitals dramatically reduced maternal mortality.61
Fifth, it is essential that the political profile of
the problem be raised. Turkey illustrates what is
possible in this regard. Turkey’s maternal mortality rate in 2000 was 70 per 100,000 live births.
A new government capitalized on the political

Improving the delivery of maternal care is hard, but it can be done—even at
relatively low incomes, as Sri Lanka and Malaysia show. From more than 2,000
per 100,000 births in the 1930s, the maternal mortality ratio in Sri Lanka fell to
about 1,000 by 1947, and then halved to less than 500 in the next three years. By
1996, it had fallen to 24. In Malaysia, it halved from 534 over the seven years from
1950 to 1957. Then, with a halving every decade or so, it came down to 19 by
1997.
To overcome the range of institutional obstacles that hampers the effective
workings of health systems, Sri Lanka and Malaysia adopted integrated and
phased approaches. And they did this with modest total public expenditures
on health—1.8 percent of gross domestic product, on average, since the 1950s.
Health programs in both countries exploited synergistic interactions of health
care with basic education, water and sanitation, malaria control, and integrated
rural development—including building rural roads, which helped deal with
obstetric emergencies. Financial, geographic, and cultural barriers to maternal
care were addressed by ensuring a front line of competent, professional midwives widely available in rural areas, providing them with a steady supply of
drugs and equipment, linking them to back-up services, and improving communication and transportation. Simultaneously, facilities were strengthened to
provide obstetric care and deal with complications. Better organizational management improved the supervision and accountability of providers. Areaspecific mortality data were provided through monitoring systems so that
empowered communities could hold political leaders accountable, and
national and subnational actors were forced to recognize the unacceptability
of every maternal death. Finally, both countries were strongly committed to
improving the status of women: women gained voting rights before or soon
after national independence, and female education received special attention.
Source: Pathmanathan and others 2003.

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support that brought it to power and, in 2003,
undertook a Health Transformation Program,
emphasizing institutional reform, client responsiveness, and a focus on underserved areas. The
budget allocated to primary health care and prevention in underserved areas rose by 58 percent,
air ambulances were put in service for remote
populations, the health workforce was redistributed for better coverage in poor areas, and
conditional cash transfers encouraged pregnant
mothers to use prebirth hostels and deliver in
public hospitals. By 2009, the maternal mortality rate had fallen to 19.8.62
Providing education to severely
disadvantaged populations
Even as gender gaps in educational enrollment shrink nationally, they remain for poor
people and for those disadvantaged by other
circumstances—remoteness, ethnicity, caste,
race, or disability. To reach these groups, policy makers can build on experience and evidence from Cambodia, Colombia, Honduras,
Mexico, Nicaragua, Pakistan, and Turkey. A
range of options includes remedies for both supply (such as building more schools in remote areas and recruiting local teachers) and demand
(such as cash transfers conditioned on girls’ school
attendance). A key to designing cost-effective
interventions is the availability and the cost of
collecting information about local characteristics and conditions. Where relatively little is
known, less locally customized policies, such as
cash transfers conditioned on sending daughters to school, may be more effective in reducing
gender disparities. The transfers have had positive impacts on enrollments in both middleincome and lower-income settings, especially
for increasing enrollments among groups with
low enrollments to start (such as pockets of
severely disadvantaged populations).63 Having
gained wide political acceptance because of their
efficacy, such policies are being implemented in
more than 30 countries.

Policies to improve women’s economic
opportunities
Across the world, women and men access economic opportunities—whether in wage employment, agriculture, or in entrepreneurship—
in fundamentally different ways. Women tend
to occupy very different parts of the economic
space from men and are disproportionately

concentrated in lower productivity activities,
self-employment, and the informal sector. Even
in the formal wage sector, they cluster in certain
occupations and industries, usually lower paying. These differences remain even as countries
get richer.
Three factors drive these patterns. First,
women and men have very different responsibilities for care and housework, and as a result
very different patterns of time use, which impinge directly on choices of employment and
economic activity. Second, women and men
face differential access to productive inputs and
often differential treatment by markets and institutions. Third, these mutually reinforcing
constraints can generate a “female productivity
trap.” Policies thus need to target these underlying factors. Because multiple factors may be at
play more often than not, effective policy interventions may need to target several of them—
either simultaneously or sequentially.
Releasing women’s time
Gender differences in access to economic opportunities are driven in part by differences in
time use that result from deep-rooted norms for
the distribution of responsibility for care and
housework. Addressing these binding norms
and releasing women’s time means paying more
attention to three types of policies: child care and
parental leave policies; improvements in infrastructure services; and policies that reduce transaction costs associated with accessing markets.
Policies such as subsidies to or public provision of child care can compensate women for
the costs they incur within the home from
engaging in market work. Child care can be
provided either directly by the state (including
local governments) or through the private sector, possibly with public subsidies and regulation. Among developing countries, child-care
policies have been used in some middle-income
Latin American countries. Examples include
publicly provided or subsidized day care such
as Estancias Infantiles in Mexico, Hogares Comunitarios in Colombia, and similar programs
in Argentina and Brazil. The evidence from
these countries as well as from rich countries
(mainly in northern and western Europe) that
have similar schemes is that they increase the
number of hours worked by women as well as
lead them to work more in formal employment.
In lower-income countries, child-care solutions

Overview

are particularly needed for women employed
in the informal sector and rural women. In India, the nongovernmental organization (NGO)
Mobile Creches is experimenting with different models for providing child-care services for
women employed in the rural informal sector
and on public works programs. Similar efforts
have been undertaken in the Indian state of
Gujarat by the Self Employed Women’s Association, which has set up day-care centers for
the 0–6-year-old children of its members. Other
options for publicly provided day care are either to lengthen the school day (particularly
at grades where attendance is only for half of a
day) or to lower the age at which children enter
the school system.
Parental leave policies have been tried mainly
in rich countries—and these typically take the
form of maternity leave. While these policies
have increased women’s labor force participation in these countries, their applicability in developing countries may be more limited. First,
they can be used only in the formal sector, which
typically represents only a fraction of employment in emerging and low-income economies.
Second, they can actually make it less attractive
for employers to hire women of child-bearing
age unless the maternity leave is publicly financed. Policies that provide both paternity and
maternity leave and make the former mandatory
(as in Iceland, Norway, and Sweden) have the
advantage of not being biased against women
while also helping to shift the underlying norms
about care. But this approach may be financially
beyond the fiscal capacity of many developing
economies.
Improvements in infrastructure services—
especially water and electricity—can help free
up women’s time spent on domestic and care
work. Electrification in rural South Africa, for
instance, has increased women’s labor force participation by about 9 percent; in Bangladesh, it
has led to more leisure time for women. In Pakistan, putting water sources closer to the home
was associated with increased time allocated to
market work. Other studies show no impact
on market work but noticeable impacts on leisure time, which also increase women’s welfare
(chapter 7).
Interventions can also focus on reducing the
(time) transaction costs associated with access to
markets. Better and more effective transport options can reduce the time costs associated with

working outside the home, making it easier to
manage the multiple burdens of house, care,
and market work. And information and communication technologies can help reduce both
the time and mobility constraints that women
face in accessing markets and participating in
market work. Mobile banking programs, such
as M-PESA in Kenya, are allowing women to
process small financial and banking transactions more effectively and promoting savings,
which is especially beneficial to small women
entrepreneurs. In India, a program run by an
NGO, the Foundation of Occupational Development, organized groups of women to focus
on marketing, provided them with access to
cell phones and the Internet, thus helping them
market their products directly and increase their
profit margins.64
Closing gaps in access to assets and inputs
Female farmers and entrepreneurs have less access to land than their male counterparts. Similarly, both the demand for and use of credit are
lower among female farmers and entrepreneurs
than among their male counterparts. These differences are rooted in failures of markets and institutions and in their interactions with household responses. For example, accessing credit
often requires collateral, preferably land or immobile assets. Women are thus at a disadvantage
because they have lower or less secure access to
land and are disproportionately employed in the
service sector where capitalization is lower and
output is often intangible. These forces may be
further reinforced by gender-based preferences
in the households that can lead to unequal resource allocations (of land, for example) to male
and female members.
Policies need to focus on these underlying
determinants of differential access—leveling
the institutional playing field by strengthening
women’s ownership rights, correcting biases in
service delivery institutions, and improving the
functioning of credit markets.
Strengthening women’s land and ownership
rights can help female farmers and entrepreneurs.
The main constraint that needs to be addressed
is the restriction on women’s ability to own and
inherit assets and to control resources. Experience from India and Mexico shows that equalizing provisions of inheritance laws between
women and men increases asset ownership by
women. Discriminatory land laws, which lie

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at the root of agricultural productivity gaps in
many countries, also need to be reformed to
provide, at least, for joint ownership in marriage,
increasing women’s ability to use land in accessing economic opportunities. An even better way
to secure married women’s land rights (especially in the case of divorce or death of a spouse)
is mandatory joint land titling. In two regions
in Ethiopia where land certification involved the
issuance of joint titles to both spouses, women’s
names appeared on more than 80 percent of all
titles, four times the 20 percent in the region
where the certificate was issued only in the name
of the household head.65
Correcting biases in service delivery institutions such as the workings of government land
distribution and registration schemes and agricultural extension agencies can improve women’s access to economic opportunity in many
countries. Redressing these biases requires actions on several fronts. First, service providers
need to target women explicitly and additionally. For example, land redistribution programs
that target the head of the household will not
serve women well. Instead, governments can put
in place mandatory joint titling on redistributed
land that is coupled with gender sensitization
policies and more female representation on local
land boards. Second, women can be given some
power within the service delivery organization,
including in setting priorities. For agricultural
extension, for example, women could be put
in decision-making positions at the Ministry
of Agriculture. Third, technology can be used
to expand the reach of services, as was done in
Kenya for agricultural extension through the
use of call centers. Fourth, improved monitoring can make the problem visible. Finally, the
female users of the service should be provided
information on the level of service they are due.
This step can be aided by building the collective
element of demand—for example, supporting
women’s farmer organizations.
Improving the functioning of credit markets by
addressing the information problems caused by
lack of experience with women borrowers can
help address productivity gaps between women
and men in agriculture and entrepreneurship.
Microcredit schemes have been the most common way of addressing these problems, by helping women access small-scale credit and build a
track record of borrower performance. Typically,
these take the form of group lending schemes

such as Grameen Bank in Bangladesh and
FINCA in Peru. Microcredit has now evolved
beyond group lending to such schemes as Banco
Sol in Bolivia and Bank Rakyat Indonesia that
offer larger individual loans and rely on repayment incentives rather than peer monitoring.
Lack of access to formal credit can also be surmounted through financial innovation and by
adapting a credit model that addresses the needs
of small businesses, as Access Bank in Nigeria,
DFCU in Uganda, and Sero Lease and Finance
in Tanzania have done. Recognizing that women
are less likely to have established credit records
than men, and lower asset bases on which to
draw for collateral, these large commercial
banks partnered with the International Finance
Corporation to develop new instruments to
support and extend credit services to femaleowned businesses and female entrepreneurs. Interventions included developing new products
such as loans that are collateralized with equipment or based on cash flow as well as training
for the staff of financial institutions and strategic support to help banks increase their number
of female clients. Initial experience with these
interventions shows an increase in the shares of
female clients using financial services and taking
out larger loans with better-than-average repayment (chapter 7).
Addressing discrimination in labor markets
In wage employment, the underrepresentation
of women in certain sectors or occupations can
feed discriminatory beliefs among employers
(or reinforce preexisting beliefs) that women are
not suitable workers or good candidates for employment. The importance of networks (often
gendered) in job search and professional promotion can further reinforce women’s exclusion
from certain jobs, positions, sectors, or occupations. Breaking this information problem and
expanding networks can be addressed through
three main types of policies: active labor market
policies; affirmative action programs; and group
formation and mentoring interventions.
Active labor market policies combine training,
placement, and other support to enable women
to enter or reenter the workforce. Although
these policies are not typically motivated by the
goal of narrowing gender wage gaps, evidence
from Argentina, Colombia, and Peru indicates
that they can increase women’s employment
and earnings in the formal sector by allowing

Overview

BOX 6

Catalyzing female employment in Jordan

Despite growing education levels, labor force participation rates for women in the Middle East and
North Africa remain very low. In Jordan, only 17
percent of 20- to 45-year-old women work, compared with 77 percent of men. This labor force
participation gap also holds among the more
educated; among community college graduates
it starts immediately on graduation. These low
employment rates make it difficult for new graduates seeking to enter the labor market. With few
women employed, young women lack role models
to follow into employment as well as the network
connections to help them find jobs. Employers,
lacking experience with working women, may be
reluctant to hire women if they believe women are
less committed to staying employed.
The Jordan New Opportunities for Women
(Jordan NOW) program is a pilot to rigorously evaluate the effectiveness of two policies: short-term
wage subsidies, and employability skills training.
Short-term wage subsidies give firms an incentive to take a chance on hiring young female graduates and an opportunity to overcome stereotypes
by directly observing young women working for
them. The subsidies can also give young women
more confidence to search for work and to
approach employers. In the pilot, each voucher
has a value equal to the minimum wage for six
months.
Employability skills training augments the
technical skills that graduates learn in community
college with the practical skills to find and succeed in employment. Many employers say recent
graduates lack these interpersonal skills and other
basic job skills. In the pilot, students received 45
hours of instruction in team building, communications, presentations, business writing, customer

service, resume writing, interviewing, and positive
thinking.
There appears to be strong demand for these
policies. Despite low employment rates, the majority of recent female graduates want to work: 93 percent say they plan to work after they graduate, and
91 percent say they would like to work outside the
house after they are married. Of those invited to
attend the training courses, 62 percent completed
them, with unmarried women more likely to attend.
Those who began the courses gave them positive
reviews, claiming the courses had given them much
more confidence to begin searching for jobs. Four
months into the wage subsidy program, about a
third of those using vouchers had found a job.
Early results from a midline evaluation suggest
that job vouchers have significant employment
effects: employment rates among graduates who
received vouchers alone or vouchers plus training
are between 55 to 57 percent compared with 17 to
19 percent among those who received training
alone or received neither training nor vouchers. In
all groups, employment effects are higher for
unmarried women. Financial empowerment (measured as the proportion of women who have their
own money and can decide how to use it) also
increased significantly for all who received either
vouchers or training or both. Follow-up surveys
will determine whether these employment effects
of job vouchers are sustained in the longer term
and will also focus on other measures of empowerment and changes in attitudes. The surveys will
also allow further investigation of the link between
marriage and work, given the early findings that
married women are less likely to attend the training, less likely to use the vouchers, and less likely to
be employed.

Source: WDR 2012 team.

participants to better communicate their abilities to employers. A similar program currently
under implementation and evaluation in Jordan
shows promising signs of success (box 6).
Affirmative action is another way to overcome information failures. The goal is to push
women’s participation in wage employment to
a “critical threshold” (often argued to be about
30 percent), where information failures and
networks no longer bind. Experience (mainly
from rich countries) shows that affirmative action works best if it is mandatory. Affirmative
action also can be implemented through public
sector employment and contracting, but clear

rules, careful monitoring of impacts, and credible sanctions for noncompliance are essential.66
Where such programs have been implemented,
the effect has clearly been to redistribute wage
employment from men to women. And, while
the economic efficiency of such policies is still debated, the most comprehensive evidence (from
long experience in the United States) points to
little or no adverse efficiency effects.67 This experience and that in other countries also show
that any potential negative efficiency impacts
can be addressed by ensuring that the affirmative action programs are temporary and are removed once women’s representation reaches the

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needed critical mass. In the absence of explicit
affirmative action policies, female employment
in the public sector in fairly large numbers can
have a demonstration effect. In rich countries,
public sector growth has been important in integrating women into the labor markets.68
Supporting the creation of women’s networks
can be effective where gendered networks hinder
women workers, farmers, or entrepreneurs. Such
interventions work best when they combine the
building of social capital and networks with the
provision of training, information, and mentoring. One example is the Jordan NOW program
described in box 6. Another, more established
example, is the Self Employed Women’s Association in India, which has evolved into an effective organization representing the interests of
a large number of informal sector workers and
entrepreneurs, providing extensive information,
support, and training services to its members.
Removing discriminatory treatment in labor laws and regulations can promote women’s
economic opportunities. Among these laws and
regulations, the priority should be to revisit
the limits (including outright bans) on parttime work in many countries. Because women
provide a disproportionate share of household
and care work, such restrictions end up limiting work options for women much more than
for men. Relaxing these prohibitions would
give women more opportunities for paid employment. In Argentina, removing the ban on
part-time contracts in the formal sector led to
a significant shift of women with children from
part-time work in the informal sector to parttime contracts in the formal sector.69

Policies to shrink differences in voice
Increasing women’s societal voice
Women generally have less voice than men
both in society and in households. At the societal level, income growth does little to reduce
these gaps. Norms that dictate that politics is for
men; beliefs that women make worse leaders,
which are fed in part by the low participation
of women in politics; norms around care and
housework, which limit the time available to
women to participate in formal political institutions; and the gendered networks within politics
that work against women all matter more than
income growth.

Because these constraints resemble the ones
that limit women’s prospects in labor markets,
the policy solutions are similar. Quotas and
other types of affirmative action have promoted
women’s political representation at various levels of politics. Such measures range from voluntary commitments by political parties to include women candidates on their electoral lists
to specifying shares of legislative seats reserved
for women. Which option is best for a country
depends on its political system. For example,
reserving individual seats for women will not
work in proportional representation systems,
whereas voluntary party quotas may work when
parties have strong leadership and internal discipline. Whatever the system, its design and enforcement are critical. In Spain, where positions
on the ballot for the Senate were in alphabetical
order, parties tended to choose women with last
names that landed lower in the ballot and who
thus were less likely to win a seat. 70
Broader tensions also need to be acknowledged and taken into account if quotas are used
to increase women’s political representation.
Mandatory quotas involve the state circumscribing part of the democratic process, so this
distortion has to be balanced against the need to
redress persistent inequalities. One option, taken
by local governments in India, is to implement
quotas on a rolling basis—with a different set of
seats chosen for reservation in different elections
over time. And as with all affirmative action, it
helps to specify a clear goal or time period up
front. The structure of the reservation also matters. Designating particular seats for women
runs the risk of creating “token” women’s seats.
Quotas have increased female representation. In Mexico, candidate quotas increased the
share of women in parliament from 16 percent
to more than 22 percent. Reserved seats in Morocco increased the proportion of women in
parliament from less than 1 percent to almost 11
percent. Quotas in local governments in India
also showed that such measures can change underlying beliefs among voters about the efficacy
of women politicians, even in a short period,
and increase the proportion of women elected
to these positions even after the quotas are no
longer in place.71
Affirmative action in the political realm
needs to be complemented by measures that
increase women’s voice in other societal institutions, such as trade unions, corporations, the ju-

Overview

Increasing women’s voice within households
The muted voice of women within their households reflects the combined influence of their
more limited access to economic opportunities,
the nature of social norms, the legal framework,
and the enforcement of laws. Key determinants
of control over household resources are access to economic opportunities and the legal
framework—particularly rights over property
and those that determine access to assets. For
domestic violence, social norms and the content
and enforcement of laws are important. And for
fertility, norms, bargaining power, and service
delivery are critical.

work, and jobs requiring higher skills.72 Morocco also reformed its family laws in the 1990s,
and in 2004 the new Family Code completely
eliminated references to the husband as the head
of the household.
Greater effort is also needed to make these
rights more effective and justice systems more
responsive to women’s needs. Interventions are
needed on both the supply side and the demand side. Greater capacity of the institutions
that apply the laws, more accountability in the
justice system to promote predictable outcomes
in line with the law, and procedures to promote
women’s access to justice and women’s representation in judicial institutions are critical on
the supply side. Also important are mechanisms
for the implementation of laws. Evidence from
Ethiopia illustrates how the procedures around
mandatory joint land titling helped promote
women’s rights over land. Women’s demand for
enforcement of their rights can be promoted by
broadening literacy, increasing the accessibility
of legal aid services, and reducing costs of legal
procedures. And data have to be collected and
made public so that the problems of women’s
access to justice are made more visible.

Increasing control over household resources
Thus, the most promising policies to increase
women’s voice in households center on reforming the legal framework so that women are not
disadvantaged in controlling household assets
and expanding their economic opportunities.
For the legal framework, land laws and aspects
of family law that govern marriage, divorce,
and disposal of property are particularly important. A cross-cutting issue applies to the
many countries where multiple legal systems
exist. Reconciling these systems, which may include customary and religious law, is a priority,
especially to ensure that all laws are consistent
with a country’s constitution. Kenya made such
changes in its recent constitutional reforms.
Although reforms in these areas are politically and socially complex and depend very
much on country context, experience shows that
change is possible. Ethiopia reformed its family
law in 2000 by eliminating the husband’s ability
to deny permission for his wife to work outside
the home and requiring both spouses to agree in
administering family property. The first phase
of these changes shifted women’s economic activities toward work outside the home, full-time

Reducing domestic violence
Reducing domestic violence requires action
on multiple fronts. The goal is to prevent violence before it happens. The first step is to enact laws that define different types of violence
against women, prescribe mandates and duties
for enforcement and investigation, raise societal
awareness, and signal a government’s commitment. These laws must be put in place in countries that lack them, especially in the Middle
East and North Africa, South Asia, and SubSaharan Africa. And countries with such laws on
the books need to make them more specific and
actionable.
A second step is to shift norms and behaviors
around domestic violence to emphasize prevention. Education and awareness programs, such
as Soul City in South Africa, can change norms
about domestic violence among both men and
women. Increasing women’s bargaining power
in their households—by improving women’s
economic opportunities and enhancing their
control over resources and their ability to leave
marriages—also can change behavior. But increasing women’s bargaining power can also
risk increasing the likelihood of violence in the

diciary, and professional associations. This can
be done through quotas as well as by mentoring
schemes, women’s networks, and skills development in these realms targeted to women. Collective action by women’s groups can be particularly effective in this, as with the Self Employed
Women’s Association in India. More generally,
because women tend to be better represented
in less formal organizations, laws and regulations should ensure a level playing field for such
organizations.

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short term. So, specific mitigation measures may
be needed.
Third, when violence does occur, victims
need timely and effective assistance ranging
from the police and judiciary to health and
social services, as with support integrated in
Malaysia’s one-stop crisis centers at government hospitals. Service providers—police and
judiciary, health, and social services—need to
target women explicitly and additionally. Targeting women also requires bringing services
closer to women to deal with time and mobility
constraints—for example, by providing community paralegals and mobile legal aid clinics
that enable women to use the justice system.
In many contexts, bringing services closer to
individuals (demand) can be combined with
increasing the awareness of service delivery organizations, particularly management, about
gender issues (supply). PEKKA Women’s Legal Empowerment in Indonesia trains village
paralegals, with a focus on domestic violence
and family law. Another way of improving
women’s access to justice is to increase the share
of women in the judicial and police forces responsible for addressing domestic violence.
The Indian state of Tamil Nadu introduced
188 all-women police units to cover both rural
and urban areas and to focus on crimes against
women. These units increased women’s comfort in approaching the police, including making reports of domestic abuse.73
Increasing control over fertility
Increasing women’s control over their fertility
requires actions in several areas. Availability of
family planning services is still limited in parts
of the world. In some cases the underserved
population covers entire countries, but more
often these women live in specific geographic
areas within countries —usually rural areas—or
are poor. For these groups, improved delivery of
family planning services is a priority.
Control over fertility decisions—the number and spacing of children—goes beyond issues related to provision of reproductive health
services, so two other policy areas need to be
addressed. The first is to boost women’s ability
within the household to voice their preferences regarding number and spacing of children. As discussed earlier, access to economic opportunities,
control over assets, and appropriate laws help. So
does educating men on the benefits and use of

contraception. Contraception uptake is higher
when husbands are included in family planning
education, as was shown in Bangladesh74 and in
Ethiopia. 75
The second is increasing the quality of family planning services. Improvements in this regard need to focus on three areas. First, a sufficient range of contraceptive options needs to
be available. Second, adequate information on
the available options, their side effects, and the
advantages and limitations of different methods
needs to be given to women so they can make
an informed decision. Third, services need to
be provided in a manner that protects the individual’s or the couple’s privacy. This will require training health care providers in protocols
designed specifically for family planning. Recent
experience in Zambia shows that very different
outcomes regarding fertility and contraception
can result depending on whether women are approached individually and in private or together
with their partners.

Policies to prevent the reproduction of
gender inequality across generations
The reproduction of specific gender inequalities across generations gives rise to “gender inequality traps,” which are likely to most affect
the poor and excluded in society. Women’s lack
of political voice means that the market and institutional failures feeding gender inequality are
unlikely to be corrected. Income growth alone
does little to address the processes that underlie
these persistent gaps. The previous sections dealt
with policies to address three of these gaps that
reproduce over generations—reaching pockets
of remaining disadvantage in education, increasing women’s voice and participation in societal institutions, and increasing women’s voice
within households. Here, we address measures
to address the gender inequalities in human
capital, opportunities, and aspirations that are
set early in life.
Decisions in adolescence can shape skill acquisition, health outcomes, and economic opportunities. Adolescence is also a period when
one’s lifelong aspirations are molded, and when
social norms and perceptions start to bind for
boys and girls. Horizons for girls often shrink,
especially for poor girls or girls in rural areas
where distance and norms for mobility can
be a significant constraint. Empowering adolescents to make better choices for themselves

Overview

can make a big difference to their lives, to their
families, to their communities, and, as future
workers and citizens, to society more broadly.
Interventions need to build human and social
capital; facilitate the transition from school to
work; and increase their aspirations and agency.
Efforts to influence and reduce risky behavior
are also important.
Scholarships and conditional cash transfers can increase school attendance and reduce
dropout rates for adolescents, especially girls.
These positive impacts are well documented
in Latin America in countries such as Colombia, Ecuador, Mexico, and Nicaragua.76 More
recently, evidence from Africa is beginning to
show similar results. In Malawi, fairly small
cash transfers to girls increased enrollment and
reduced dropout rates.77 Moreover, while these
transfers were aimed at education, they had
benefits in other realms, such as reducing HIV
infections. Other tools can also be brought to
bear to help girls stay in school. Providing them
with information on the returns to schooling
is one such tool: for example, in Madagascar,
information on earnings for primary school
completers provided to boys and girls as well as
their parents increased attendance rates by 3.5
percentage points.78 In the Dominican Republic,
a similar effort to provide accurate information
on actual returns to education to boys also had
a positive impact.79 Other evidence suggests that
incentives (prospects for winning a scholarship
or direct payments for performance) can affect
children’s own perception of their abilities and
can improve test scores.80
Vocational training targeted specifically to
youth increased both the likelihood of employment and the earnings for young women in
Colombia and Peru.81 In Kenya, providing information to young girls about the relative returns to vocational training in male or femaledominated industries increased girls’ enrollment
in trade school courses that prepared them for
typically male-dominated trades that yielded
higher returns.82 The Adolescent Girls Initiative
aims to evaluate a range of these interventions,
including skills training and mentoring, in a
number of low- and middle-income countries
(box 7).
Health education programs have proved to be
effective in reducing risky behaviors. A program
in rural Tanzania substantially improved sexual
knowledge, attitudes, condom use in both sexes,

and reported sexual behavior in boys.83 For
adolescents, the promotion of contraception,
when combined with education interventions
and skill building, and appropriately targeted
to cultural and social settings, can be effective
in reducing unintended pregnancies.84 Such a
program for adolescent girls in Uganda resulted
in a significant increase in condom use and a
lower number of children among participants.85
Sometimes, economic empowerment alone can
have a marked impact. A recent evaluation of a
youth job training program in the Dominican
Republic that included life skills training plus an
apprenticeship showed a significant reduction
in pregnancies among participants.86
Exposure to female role models whose positions of leadership or power contradict stereotypes of women’s role can reduce the intergenerational transmission of gender norms. A study of
political reservation for women in India showed
that teenage girls who have repeated exposure to
women leaders are more likely to express aspirations that challenge traditional norms, such as
a desire to marry later, have fewer children, and
obtain jobs requiring higher education.87 Increased economic opportunities for young girls
can also change their own and their communities’ perceptions of gender roles for adolescent
girls. A study of a program in Delhi that linked
communities to recruiters for high-paying telephone work found that these communities were
more likely to have lower expectations of dowry
and to find it acceptable for women to live alone
before marriage and to work before and after
marriage or childbirth.88

Making other policies “gender-smart”
Understanding how gender factors into the
workings of households, markets, and institutions can matter for policies even when improving gender equality is not the main objective.
Why? Because gender-differentiated failures in
markets, gender biases in institutions, and the
way gender relations play out in the household
all affect (and sometimes constrain) the behavior of both men and women. These changes in
behavior can affect how men and women respond to policies. Failing to take them into account can thus mean the policy will have unintended consequences or simply not work.
Take relations within the household. They
clearly affect how the household responds to
policy—sometimes with unintended conse-

The Adolescent Girls Initiative, a public-private
partnership, promotes the transition of adolescent girls from school to productive employment
through innovative interventions that are tested
and then scaled up or replicated if successful.a
Under way in Afghanistan, Jordan, Lao People’s
Democratic Republic, Liberia, Nepal, and South
Sudan (and soon in Rwanda), the initiative targets
about 20,000 adolescent girls and young women
ages 16–24.
Interventions range from business development skills training and services to technical and
vocational training, targeting skills in high demand.
In all projects, girls receive life-skills training to
address the most important barriers to their economic independence. Each country intervention is
tailored to the local context and specific needs of
adolescent girls. Because the evidence on what
works is thin, rigorous impact evaluation is a part
of the initiative.
The skills training aims to equip girls with technical skills with proven demand in the local labor
market. In all pilots, training providers are asked to
conduct market assessments before selecting
trades for which training is developed and offered.
While the focus is on matching skills to the market, the results in many cases challenge norms for
gender-appropriate occupations.
In Liberia, participating young women are
offered six months of training for jobs in house
painting, professional driving, and security guard
services. In Nepal, they are offered three months
of occupational skills training followed by a mandatory skills test and three-month job placement.
The focus is on identifying nonstereotypical

trades attractive to women, with some trained as
electricians, masons, and mobile phone repair
technicians.
Lessons from implementation highlight girls’
distinctive social capital needs, which must be
addressed to facilitate the uptake of economic
opportunities among often vulnerable and isolated young females. Trainers in the Liberia pilot
formed girls into teams of three or four, who made
public commitments to support one another, both
inside and outside the classroom, throughout the
training. The positive peer pressure helped keep
attendance rates high, with almost 95 percent
completing the training, and addressed the variety of educational levels among participants.
Another promising innovation from the Liberia pilot was a formal savings account at a local
bank for all participating girls, with an initial
deposit of $5. The savings accounts not only
enabled the girls to practice their financial literacy
skills beyond the classroom but built trust with
formal financial institutions, and girls expressed
satisfaction with being connected to the modern
economy for the first time.
Job fairs were organized to market the program to potential employers interested in placing
girls in internships or jobs. Private sector human
resource and career development specialists met
with trainees individually to impart their knowledge about the industry, coach them on professionalism in the workplace, and give constructive
feedback on the skills demonstrated. These oneon-one meetings offered girls the opportunity to
build networks and to tap into industry-specific
information crucial for new job entrants.

a. Current donors to the Adolescent Girls Initiative include the Nike Foundation, a main partner of the initiative, as well as the governments of
Australia, Denmark, Norway, Sweden, and the United Kingdom. The Bank’s Gender Action Plan also supports the initiative’s country projects.
Pledges to the initiative stand at $22 million.

quences. For example, many conditional cash
transfer programs initially targeted women because—cognizant of how women were likely to
spend money differently from men—it seemed
a way to get more of the transfer spent on children’s endowments. But the transfers changed
bargaining power within the household and, in
some cases such as Mexico, resulted in shortterm increases in domestic violence. While this
effect can disappear or change in nature in the
longer term, a number of later transfer programs included conditions to discourage domestic violence (Brazil), training and awareness

of these issues for mothers and families (Colombia, Peru), or even dedicated social workers
(Chile).
So, how can considerations of gender inequalities and their underlying determinants
be integrated into broader policy and program
design? The analytical framework in this Report
provides a guide. First, what happens inside the
household shapes the impact of policies. An example comes from Papua New Guinea. Gender
roles in harvesting oil palm have men climbing
the trees and harvesting the fruits, while women
collect the fruit that has fallen on the ground.

Overview

The oil palm industry came to the realization
that 60–70 percent of the fruit on the ground
was not being collected. They tried multiple
initiatives designed to deal with constraints
women faced, including giving the women special nets to use, and timing the collection to
deal with women’s care duties. None of these
worked. Finally, the Mama Lus Frut scheme was
introduced whereby women received their own
harvest record cards and were paid directly into
their personal bank accounts. Yields increased
significantly, as did female participation in oil
palm harvesting.
Second, many non-gender-focused policies
and programs can benefit from taking into account women’s underrepresentation in markets,
sectors, or occupations, a situation that can cause
information problems not only for women but
also for those who seek to employ them, lend to
them, or provide them with services. One example of how to take women’s underrepresentation
into account is Ecuador’s program to expand
credit bureau databases to include microfinance.
This intervention will help microfinance institutions make better lending decisions, independent of to whom they are lending. And because
microfinance clients are predominantly women,
it will also help them access a broader range of
financial services.
Third, policy design should seek to level the
playing field for women and men, especially
where laws and regulations treat them differently and where systems enforce laws and
regulations differentially, even when nominally equal. Looking for and fixing this type of
discrimination when revising laws and regulations or enforcement mechanisms can provide
an opportunity to improve gender equality as a
secondary benefit. Take the case of taxes, which
can explicitly discriminate against women
when women face different rates for the same
income as men. For example, in Morocco,
the tax allowance for children is allocated to
men, so men face a lower tax burden. Women
receive this allowance only if they prove that
their husband and children depend financially
on them. This design is neither efficient not
gender equitable.
When these considerations are factored into
general policy design, the policies are more
likely to reach their intended objectives, and it
becomes easier for policy makers to tweak them
to improve gender equality in the process.

THE POLITICAL ECONOMY OF
REFORMS FOR GENDER EQUALITY
Well-designed public policies to address specific
market failures and institutional or normative
constraints can support significant advances in
gender equality. But the choice of policies and
their implementation does not occur in a vacuum. Policies must be attuned to countries’ institutional, social, and political environment and
to the societal actors involved. It is important to
understand how reforms actually take place and
what factors allow them to be sustained so that
they produce change.
Two characteristics of gender reform processes are worth noting. First, as with all reforms,
they redistribute resources and power between
groups in society, including between men and
women. Even when policies to advance gender
equality are well chosen and enhance economic
efficiency, some groups may lose as a result.
Second, such reforms often confront powerful societal norms and beliefs regarding gender
roles. Each of these features means there will
likely be opposition, and managing this pushback is the key to successful reforms.
A range of countries—rich and developing—show that several aspects of the political
economy of reforms are especially relevant to
gender equality. First, reforms are most likely to
succeed when support for them is broad-based.
It is essential, then, to build coalitions that mobilize around the reforms. These coalitions can
include nonstate actors such as political parties,
trade unions, civic organizations and associations, and the private sector. Women’s groups in
particular have been a driving force for greater
gender equality in labor legislation and family
law. For instance, women workers in the informal sector have challenged their employers and
sometimes the state through such organizations as the Self Employed Women’s Association
in India and Nijera Kori in Bangladesh. These
groups have provided voice for women and created space for public action to counter the resistance to reform.
Women and men are partners in improving
gender equality. While most initiatives that call
on men to support gender equality are still small,
signs point to broader engagement in many areas
and growing male support for women’s rights
in many developing countries. For instance, the
Rwanda Men’s Resource Center engages men

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and boys in combating gender-based violence.
In surveys of male attitudes toward gender
equality in Brazil, Chile, Croatia, and Mexico,
adult men overwhelmingly express the view that
“men do not lose out when women’s rights are
promoted.”89 Even in India, where men in this
survey were less supportive of gender equality
overall, their support for some policies, such as
quotas in universities and places in government,
was strong.
Second, firms—big and small—can articulate
a compelling business case for gender equality. In
a fast-changing global economy, the demand for
skills has swelled, encouraging firms to expand
their talent pool. Businesses have sought not
only to attract and recruit female talent but also
to retain it through measures to facilitate worklife balance. Firms know that a diversity of opinions can enrich decision making and stimulate
ingenuity. And gender equality per se has grown
to be a desirable trait that customers and investors look for. Corporate social responsibility is
an avenue for firms to enhance competitiveness
through product differentiation and capture the
loyalty of women’s growing market power.
Third, shocks and exogenous changes can
present policy makers with windows of opportunity to launch reforms that can improve gender outcomes. Such windows sometimes stem
from unpredictable circumstances, such as a
national disaster. In 1998 the disaster that followed Hurricane Mitch in Nicaragua facilitated
a dialogue on domestic violence. A national
campaign and the enactment of legislation followed. Other windows come from shifts in the
political or economic landscape. The changes in
Spain during the democratic transition in the
late 1970s were particularly dramatic for family law and reproductive rights. And still others emerge from the advocacy of transnational
agencies and role modeling in the global agenda.
For example, the monitoring and advocacy by
Colombian local women’s groups in CEDAW
informed the expansion of reproductive health
guarantees in the Colombian Constitution, adopted in 1990, and facilitated greater access to
contraception.
Finally, there are multiple paths to reform.
Often governments follow societal cues in pacing
and pushing reforms. When policy formulation
and implementation follow cues from ongoing
shifts in markets and social norms, convergence
and alignment can fuel sustainable change. But

such “incremental” reforms may not be enough
to overcome the path dependence and institutional rigidities that result in persistent gender
inequality. Bold government action with “transformative” reforms may be necessary to alter
social dynamics and move to a more equitable
equilibrium. In choosing between incremental and transformative policies as part of gender reforms, the challenge for policy makers is
to balance the pace of change with the risks of
reversal. Incremental policies will bring about
change only slowly. But transformative policies
can risk a backlash. A way forward is to be selective in implementing transformative policies
and ensure that adequate attention is paid to
their implementation.

A GLOBAL AGENDA FOR GREATER
GENDER EQUALITY
Domestic action is central to reducing inequalities. Global action—by governments, people
and organizations in developed and developing
countries, and by international institutions—
cannot substitute for equitable and efficient
domestic policies and institutions. But it can
enhance the scope for and impact of domestic
policies. And it can influence whether global
integration and the opportunities it brings—
through information, mobility, and technology—lead to greater gender equality and better
lives for all women, or just for some.
Global action should focus on areas where
gender gaps are most significant both intrinsically and in terms of their potential development payoff—and where growth alone cannot
solve the issues. In other words, international
action should focus on complementing country
efforts along the four priority areas identified in
this Report:
• Reducing excess female mortality and closing
education gaps where they remain
• Improving access to economic opportunities
for women
• Increasing women’s voice and agency in the
household and in society
• Limiting the reproduction of gender inequality across generations
In addition, there is one cross-cutting priority: supporting evidence-based public action

Overview

through better data, better knowledge generation and sharing, and better learning.
The motivation for an agenda for global action is threefold. First, progress on some fronts
requires channeling more resources from rich
to developing countries (for example, to create greater equity in human endowments or to
tackle the root causes of excess female mortality around the world). Second, effective action
sometimes hinges on the production of a public good, such as the generation of new (global)
information or knowledge. And third, when the
impact of a particular policy cuts across borders,
coordination among a large number of countries and institutions can enhance its effectiveness, not least by building momentum and pressure for action at the domestic level.
Based on these criteria, initiatives included
in the proposed agenda for global action can be
grouped into three types of activities:
Providing financial support. Improvements
in the delivery of clean water and sanitation or
better health services, such as the ones needed
to bring down excess female mortality among
girls and mothers in the developing world, will
require significant resources—often beyond the
means of individual governments, particularly
those of relatively poor countries. The international development community can financially
support countries willing and able to undertake
such reforms in a coordinated manner through
specific initiatives or funding facilities to ensure
maximum impact and minimize duplication.
Fostering innovation and learning. While a
great deal has been learned about what works
and what does not when it comes to promoting greater gender equality, the truth remains
that progress is often held back by the lack of
data or adequate solutions to the most “sticky”
problems. That is the case, for instance, regarding gender differences in time use patterns and
the norms around care they stem from. The development community could promote innovation and learning through experimentation and
evaluation in ways that pay attention to results
and process, as well as to context, and thus facilitate a scaling-up of successful experiences.
Leveraging effective partnerships. As chapter
8 makes clear, successful reform often requires
coalitions or partnerships that can act within

and across borders. Such partnerships could
be built among those in the international development community around funding issues,
with academia and think tanks for the purpose
of experimentation and learning, and, more
broadly, with the private sector to promote access to economic opportunities. Together, these
partnerships could support countries in leveraging the resources and information needed to
successfully promote gender equality in today’s
globalized world.
The relative importance of these activities will obviously vary across countries. Table
2 provides a bird’s eye view of the proposed
agenda for global action (described in more detail in chapter 9). Areas marked with a check are
those where new or additional action is needed
or where a refocus of existing initiatives is called
for. Of course, there are also important ongoing
efforts in the areas not marked with checks—for
instance, innovation around the delivery models
for the prevention of HIV/AIDS, or partnerships
focused on adolescents. In these latter areas, the
focus should be on sustaining ongoing efforts and
partnerships, and meeting prior commitments.
Finally, the framework and analysis presented
in the Report provide four general principles for
policy and program design, which can enhance
the impact and effectiveness of global action
across all priority areas. These principles are:
• Comprehensive gender diagnostics as a precondition for policy and program design. Gender disparities persist for multiple reasons:
there may be a single institutional or policy
“fix” that is difficult and easily blocked; there
may be multiple reinforcing constraints in
markets, formal institutions, and households
that combine to block progress; or they may
be deeply rooted in gender roles or social
norms that evolve only slowly. Effective policy design requires a good understanding of
which of these situations prevails in a particular context, and of where and what the
binding constraints are. To be useful, this diagnostic must drill down into what happens
in households, markets, and formal institutions, their interactions, and how they are
shaped by social norms.
• Targeting determinants versus targeting outcomes. In choosing and designing policies,
it is necessary to target the market and institutional constraints that generate existing

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TA B L E 2

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

The agenda for global action at a glance
Directions for the global development community

Priority area

Closing gender gaps in
human endowments

Promoting women’s access to
economic opportunities

Closing gender gaps in voice
and agency

Preventing intergenerational
reproduction of gender
inequality

New/additional initiatives
that need support

Providing ﬁnancial
support

Increasing access to education
among disadvantaged groups

√

Increasing access to
clean water

√

√

Increasing access to
specialized maternal services

√

√

Strengthening support for
prevention and treatment of
HIV/AIDS

√

Increasing access to child
care and early childhood
development

√

Leveraging partnerships
√

√

√

√

Investing in rural women

√

Increasing women’s access to
the justice system

√

Shifting norms regarding
violence against women

√

Investing in adolescent girls
and boys

√

Generating new information
Supporting evidence-based
public action

Fostering innovation
and learning

√

√

√

√

Facilitating knowledge sharing
and learning

√

Source: WDR 2012 team.

gender gaps, rather than the outcomes themselves. These constraints may be multiple and
even outside the immediate domain where
the outcome is observed.
• “Upstreaming” and strategic mainstreaming.
Because gender gaps are often the result of
multiple and mutually reinforcing constraints,
effective action may require coordinated
multisectoral interventions, or sequential interventions. And in many instances, such
interventions can take the form of general
policies that are made “gender smart” by incorporating gender-related issues into their
design and implementation. To maximize
impact, it is thus necessary for gender issues
to be upstreamed from specific sector products and projects to country and sector programs. That will allow for more strategic
gender mainstreaming.
• No one size fits all. The nature, structure, and
functioning of markets and institutions vary
widely across countries, as do norms and cul-

tures, and as a result so do household and
individual behaviors. This implies that the
same policy can have very different results
depending on the contexts—or, as the discussion in chapter 8 makes clear, that there
are multiple paths to reform.

ender refers to socially constructed
and learned female and male roles,
behaviors, and expectations. All cultures interpret and translate the biological differences between men and women
into beliefs about what behaviors and activities
are appropriate for each gender as well as their
rights, resources, and power. For example, most
societies give the primary responsibility for the
care of infants and young children to women
and girls, and that for military service and national security to men. Gender thus shapes one’s
life chances and one’s role in the home, in society, and in the economy.
Played out over the life cycles of individuals,
gender can translate into inequalities—in human capital, economic opportunities, citizenship, and political participation. It determines
the way households allocate resources to sons
and daughters, through decisions about boys’
or girls’ education or about where they work,
with sons typically working on the farm and in
other market work while daughters work in the
home and care-giving activities. By the time girls
and boys become adults and form households,
women typically have fewer years of education
than men (although this is changing rapidly),
work longer hours but fewer in the labor force,
earn lower wages, and have less say in their communities and societies.

GENDER EQUALITY AND
DEVELOPMENT: WHY DO THE
LINKS MATTER?
Why do these gender differences matter for development, and how do they evolve as countries

develop? We argue in this Report that the links
between gender equality and development go
both ways and that each direction of this relationship matters for policy making. Higher
incomes and improved service delivery—both
essential elements of broad-based economic development—contribute to greater gender equality. That is why the rise in global prosperity in
the past quarter century has seen the unprecedented narrowing of gender gaps on many education and health outcomes as well as in labor
market opportunities. More women than men
now attend universities across the world. And
women make up over 40 percent of the world’s
labor force.
But not all gender gaps have shrunk or are
shrinking with rising incomes. Poor girls and
those who live in remote areas or belong to excluded groups are far less likely to attend primary and secondary school than boys in the
same circumstances. Compared with their highincome counterparts, women and girls in lowand middle-income countries die at higher rates
relative to men, especially in the critical years
of infancy and early childhood, and in their
reproductive years. Women continue to cluster in sectors and occupations characterized as
“female”—many of them lower paying. Women
are more likely to be the victims of violence at
home and to suffer more severe injuries. And almost everywhere, the representation of women
in politics and in senior managerial positions in
business remains far lower than that of men.
Understanding which of these gaps respond
to economic development and why they do so is
relevant to policy because it helps shine the light
on the gender gaps that need attention. The disparities between women and men or girls and

A guide to the Report

boys that shrink as countries get richer—differences in access to education, for example—need
less policy attention through a gender lens than
those that are more persistent, such as differences in wages, agricultural productivity, and
societal voice.
The reverse relationship—from gender equality to development—also matters for policy
for two reasons. First, gender equality matters
in its own right, because the ability to live the
life of one’s own choosing and be spared from
absolute deprivation is a basic human right,
to be enjoyed by everyone, whether one is male
or female. Because development is a process
of expanding freedoms equally for all people,
gender equality is a core objective in itself.
Just as lower income poverty or greater access
to justice is part of development, so too is the
narrowing of gaps in well-being between males
and females.
Second, greater gender equality can enhance
economic efficiency and improve other development outcomes. Evidence from a (slowly)
growing set of microeconomic studies points to
three main channels for greater gender equality
to promote growth:
• Reducing barriers to more efficient allocation of women’s skills and talents can generate large (and growing) productivity gains.
• Improving women’s endowments, opportunities, and agency can shape more positive
outcomes for the next generation.
• Increasing women’s individual and collective
agency produces better outcomes, institutions, and policy choices.

Misallocating women’s skills and talent
comes at a large (and rising) economic cost
Gender equality can have large impacts on productivity, especially with women now representing larger shares of the world’s workforce and
university graduates. For countries to be performing at their potential, the skills and talents
of these women should be applied to activities
that make the best use of those abilities. But this
is not always the case. Women’s labor is too often underused or misallocated—because they
face discrimination in markets or societal institutions that prevents them from having access
to productive inputs and credit, entering certain
occupations, and earning the same incomes as
men. The consequence: economic losses.

The Food and Agriculture Organization
(FAO) estimates that equalizing access to productive resources for female and male farmers
could increase agricultural output in developing countries by as much as 2.5 to 4 percent.1
Eliminating barriers preventing women from
entering certain sectors or occupations would
have similar positive effects, increasing output
per worker by 13 to 25 percent.2
These gains are large in the 21st century’s
integrated and competitive world, where even
modest improvements in the efficiency of resource use can have significant effects on growth.
In a world of open trade, gender inequality has
become more costly because it diminishes a
country’s ability to compete internationally—
particularly if the country specializes in exporting goods and services that men and women
workers are equally well suited to produce.3
Industries that rely more on female labor expand more in countries where women are more
equal.4 In a globalized world, then, countries
that reduce gender-based inequalities, especially
in secondary and tertiary education and in economic participation, will have a clear advantage
over those that delay action.
The rapid aging of the world’s population
implies that fewer workers will be supporting
growing numbers of elderly in the decades to
come, unless labor force participation increases
significantly among groups that participate less
today—mainly women. For instance, in Europe
an anticipated shortfall of 24 million workers
by 2040 could be reduced to 3 million if female
participation rates rise to those of men.5 Nor is
the problem limited to rich countries. In developing countries and regions with rapidly aging
demographic structures, like China or Eastern
Europe, encouraging women to enter and remain in the labor force can dampen the impact
of shrinking working-age populations.

Women’s endowments, opportunities, and
agency shape those of the next generation
Women’s economic empowerment and greater
control over resources also increase investments
in children’s health, education, and nutrition,
boosting future economic growth. Evidence
from a range of countries (Bangladesh, Brazil,
Côte d’Ivoire, Mexico, South Africa, and the
United Kingdom, among others) shows that
increasing the share of household income that
women control, either through their own earn-

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ings or cash transfers, changes spending in ways
that benefit children.6
Improvements in women’s health and education also benefit the next generation. Better
nutritional status and higher education levels of
mothers are associated with better child health
outcomes—from immunization rates to nutrition to child mortality.7 And mothers’ schooling is positively linked to children’s educational
attainment across a broad set of countries. In
Pakistan, children whose mothers have even a
single year of education spend one extra hour
studying at home every day and receive higher
test scores.8
Women’s lack of agency—evident in domestic violence—has consequences for their children’s cognitive behavior and health as adults.
Medical research from developed countries has
established a link between exposure to domestic violence in childhood and health problems
in adulthood. Numerous studies also document
how witnessing violence between one’s parents
as a child increases the likelihood that women
experience violence from their own partners as
adults, and that men perpetrate violence against
their partners.9

Increasing women’s individual and
collective agency produces better
outcomes, institutions, and policy choices
Across countries and cultures, men and women
differ in agency—that is, their ability to make
choices that lead to desired outcomes—with
women usually at a disadvantage. When women
and men do not have equal chances to be socially
and politically active—and to influence laws,
politics, and policy making—institutions and
policies are more likely to systematically favor
the interests of those with more influence. So,
the institutional constraints and market failures
that feed gender inequalities are less likely to be
addressed and corrected, perpetuating gender
inequality over generations.
Women’s collective agency can be transformative for society as a whole. Empowering
women as political and social actors can change
policy choices and make institutions more representative of a range of voices. Female suffrage
in the United States led policy makers to turn
their attention to child and maternal health
and helped lower infant mortality by 8–15 percent.10 In India, giving power to women at the
local level (through political quotas) increased

the provision of public goods (both femalepreferred goods such as water and sanitation,
and male-preferred goods such as irrigation
and schools). It also reduced corruption and
increased reported crimes against women along
with arrests for those crimes.11
Several studies have also examined the
relationship between gender equality and
economic growth at an aggregate level using cross-country data. Because the links between growth and gender equality go in both
directions, the results of this work are more
difficult to interpret than those of microeconomic studies (box 0.1). But combined, the
two strands of research provide considerable
evidence that gender equality and growth are
correlated and that gender equality matters
for many aspects of growth. Even so, as we argue in the box, more careful work is needed,
especially microeconomic analysis that can
establish causal relationships between gender
equality and growth and, in so doing, highlight the channels for policy to reduce gender
gaps and increase economic growth.

WHAT DOES THIS REPORT DO?
This World Development Report focuses on the
economics of gender equality and development.
It uses an economic lens to understand what underlies and drives differences between men and
women in key determinants of welfare—in human capital endowments such as education and
health, in access to economic opportunities and
productive resources, and in the ability to make
choices and take action, or agency. It uses the
same approach to explore which policy interventions and broader societal action can reduce
these gender differences and improve outcomes.
The Report does not limit itself to economic
outcomes, however—indeed, it devotes roughly
equal attention to human capital endowments,
to economic opportunities, and to agency, signaling that all three are important and interrelated in determining welfare. Nor does it ignore
the central role of social and political institutions, whether formal or informal, in determining gender outcomes.
In examining gender gaps and their patterns across countries and over time, we adopt
a strongly empirical approach, preferring rigorous and evidence-based analysis, and highlight-

A guide to the Report

B OX 0.1

Problems with estimating the effect of gender equality on growth

One thing is clear. Income and gender equality are positively correlated. Box figure 0.1 shows this correlation for one measure, the
World Economic Forum’s Index of Economic Participation and
Opportunity, which measures male-female differences in labor force
participation, wages, income, political participation, and number of
technical workers.
B OX F I G U R E 0. 1 GDP per capita and gender equality are positively

correlated

per capita GDP in 2009 (in logs)

12

10

8

6

4
0.2

0.4

0.6

0.8

1

Index of Economic Participation and Opportunity
Sources: World Development Indicators and World Economic Forum 2010.

What is not clear is whether this correlation is capturing the
effect of growth on gender equality or the effect of gender equality on growth. In reality, it is probably capturing some of both, but
we cannot tell which relationship matters more from cross-country
data.a
1. There are good reasons for the relationship to go in both directions.
First, with changes in technology (changing with economic
development), the relative return to manual skills has declined as
that for cognitive skills has increased. Second, the better service

delivery that accompanies economic development can increase
gender equality, as in education (chapter 3).
2. Other things are going on that could drive changes in both gender
equality and growth. Consider investments to improve health.
Studies of deworming and nutrition interventions show that
they benefit girls more than boys. Each intervention improves
gender equality and human capital, each of which is independently important for growth. Now consider institutional change:
institutions can boost growth, and some kinds of institutions can
improve gender equality. Suppose that a country is improving its
legal system by expanding the reach and efficiency of the courts
and police. That expansion will contribute to growth (as contracts are better enforced) and could contribute to gender equality (by making it easier for women to use justice systems). In the
data, we observe a correlation between gender equality and
growth, but this relationship is not causal—the underlying cause
is a change in institutions. So the correlation between gender
quality and growth may actually be capturing the relationship
with a third factor that is causing changes in both gender equality and growth.
3. The relationship is not robust. Empirical work shows that the correlation between gender equality and growth is quite sensitive to
time periods and countries. Work on the relationship between
female education and growth, for example, shows that results are
quite sensitive to how the analysis is done. Indeed, changes in
how this relationship is measured can cause the effect of female
education on growth to change from negative to positive.
In sum, the relationship between gender equality and growth is
not only complex—it clearly goes in both directions. Broad-brush,
cross-country studies cannot tell the magnitude of this relationship,
nor can they provide significant insights into what drives this relationship. Careful microeconomic work (some exists, but more is
needed) can provide more definitive evidence—both on the importance of gender equality for growth and on where policy interventions are needed.

Sources: Alesina, Giuliano, and Nunn forthcoming; Kremer, Miguel, and Thornton 2004; Maluccio and others 2009; Munshi and Rosenzweig 2005; Qian 2008.
a. For a more detailed discussion of these reasons, see Bandiera and Natraj 2011 and Cuberes and Teignier 2011.

ing causality where feasible. For this, we draw on
a large and growing body of quantitative gender research, complemented by new analysis—
particularly on time use; domestic violence;
mortality risks; and earnings and productivity
in labor markets, agriculture, and entrepreneurship. We also draw on new qualitative field research, which involved more than 4,000 men
and women in 98 communities from 19 developing countries (map 0.1), exploring how
gender affects their daily lives as well as their aspirations, education, job choices, decision mak-

ing, and other aspects of well-being (see box 3 in
the overview for details).12
A global report like this one cannot attempt
to provide in-depth analysis of specific country
circumstances. Nor can it cover all relevant dimensions of gender equality. Instead, the Report
proposes a conceptual framework to explain
gender inequality and recommend public policies, which can be adapted as necessary to specific countries, issues, and sectors. Building on
earlier Bank work on gender and development
(most notably on Engendering Development),

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WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

M A P 0.1

Economies where qualitative assessments were conducted

Poland
Moldova
Serbia

Afghanistan

West Bank and
Gaza

Dominican
Republic

Burkina
Faso

Bhutan
Vietnam

Sudan
(North
Sudan)

India

Yemen,
Rep.

(Orissa,
Andhra
Pradesh)

Liberia
Peru

Indonesia

Tanzania

Papua
New Guinea

(Jakarta, Banten,
Sumatera Barat)

Fiji

South Africa

(Kwazulu-Natal)
locations where WDR qualitative assessments were carried out

Source: WDR 2012 team.

the framework posits that gender outcomes can
be understood through the responses of households to the functioning and structure of markets and institutions, both formal and informal.
The Report then illustrates the use of this framework by focusing on aspects of gender equality
where there has been most progress worldwide
(education, life expectancy, labor force participation, and the extension of legal rights to
women) and those where there has been little or
very slow change (excess female mortality, segregation in economic activity, gaps in earnings,
responsibility for house and care work, asset
ownership, and women’s agency in the private
and public spheres).
This empirical approach helps establish the
link between analysis and policy choice. It emphasizes that the design of policies targeted at
reducing specific gender gaps needs to take into
account what happens in the household, as well
as the functioning and structure of markets
and formal and informal institutions—and the
interactions between all of them. Through the
analysis of alternative policies, it shows that,
when these aspects are not considered, the intended results of policy interventions can be
muted or even contrary to what is expected.

NAVIGATING THIS REPORT:
A ROADMAP
The Report has nine chapters in three parts.
Part 1—Taking stock of gender equality—presents
the facts that will then provide the foundation
for the rest of the Report. It combines existing
and new data to document changes in key dimensions of gender equality over the past quarter century and across regions and countries. Its
main message is that very rapid and, in some
cases, unprecedented progress has been made in
some dimensions of gender equality (chapter 1),
but that it has not reached all women or been
uniform across all dimensions of gender equality (chapter 2).
The contrast between the patterns and trends
described in the first two chapters of the Report
prompts one to ask what explains the progress
or lack of it. Part 2—What has driven progress?
What impedes it?—constitutes the analytical core
of the Report. It presents the conceptual framework and uses it to examine the factors that have
fostered change and the constraints that have
slowed progress. The analysis focuses on gender
differences in education and health (chapter 3),
agency (chapter 4), and access to economic op-

A guide to the Report

portunities (chapter 5)—discussing the roles
of economic growth, households, markets, and
institutions in determining outcomes in these
three spheres. Part 2 concludes with a discussion of the impact of globalization on gender
inequality, paying attention to the opportunities and challenges created by new economic
and social trends (chapter 6). The analysis in
these four chapters leads to the identification of
four priority areas for action: reducing gender
gaps in human capital endowments, promoting
higher access to economic opportunities among
women, closing gender gaps in household and
societal voice, and limiting the intergenerational
reproduction of gender inequality.
Part 3—The role and potential for public
action—presents policy recommendations, examines the political economy of reforms for
gender equality, and proposes a global agenda
for action. The discussion starts with a detailed
description of policy options addressing the
four priority areas, complemented with concrete illustrations of successful interventions in
different contexts (chapter 7). An examination
of the political economy of gender reforms follows, with an emphasis on the issues that distinguish reform in this area from other types
of redistributive or equality-enhancing reforms
(chapter 8). Global action on gender equality
should focus on complementing country efforts on the four priority areas identified in the
Report (chapter 9).

omen’s lives have improved greatly over the past decades. Enjoying ever higher education, women have
greater control over their life choices. They use those
choices to participate more in the labor force; have fewer children;
diversify their time beyond housework and child care; and shape
their communities, economies, and societies. And the pace of
change for many women in the developing world has accelerated.
But progress has not been uniform. A vast chasm persists today in more than one way. There are women in every region of
the world for whom life has not changed much. They still battle
many of the issues that women before them had to face. Some
girls still cannot go to school on a par with boys. They may not
inherit assets from their parents. And they have lower legal and
social status. Even in Sweden and the United States, change is still
hard to come by in many facets of life and the economy. Women
are paid less and are still employed disproportionately in nursing and teaching, for example, while men dominate engineering
and construction. Only 28 chief executive officers of the Fortune
1000 companies are women.
Why so much progress in some areas and so little in others?
Part 1 provides a factual foundation for the rest of the Report by
assembling existing and new data to map out patterns and trends
in gender equality over time and across regions and countries. It
takes stock of the changes in gender outcomes across the world
in recent decades. Many of these changes have occurred because
of the wave of global prosperity that has swept across much of
the developing world. Yet this prosperity has not worked for
many women around the world, and in some respects not at all.
The focus here is on three key domains of gender equality:
the accumulation of endowments, the use of those endowments
to take up economic opportunities and generate incomes, and the
application of those endowments to take actions (agency) affecting individual and household well-being.
Endowments encompass education, health, land, and other
assets such as financial resources that women and men accumulate during their lifetimes. Many, such as basic education, are
amassed at early stages in life, reflecting mostly the decisions of
parents. Others, such as material assets, are acquired later through
such mechanisms as productive labor and inheritance rights.
Access to economic opportunities determines how endowments and time generate income and consumption—key dimensions of well-being. Decisions about time allocations between
home and workplace, productive activity, and leisure take place
in the household. They depend on the value placed on women’s

potential contribution to the well-being of the household in
relation to other household members—and on views of gender roles and women’s preferences and needs.
Agency is the process by which women and men make
choices and translate them into desired outcomes. It has many
dimensions. This Report focuses on five outcomes closely associated with women’s ability to make choices: control over
resources, decision making over family formation, control
over movement, freedom from violence, and the ability to
have a voice in society.
In these three domains, shortfalls of choice are reflected in
shortfalls of welfare. These three domains matter in and of
themselves. But they are also closely interlinked. Agency allows women to build their endowments. Endowments shape
access to economic opportunities and incomes. The ability of
women to access economic opportunities and earn income
can influence their agency. And so on.
Chapter 1 documents the unprecedented gains women
have made in rights, in human capital endowments, and in
access to economic opportunities. Most countries today have
explicit guarantees in their constitutions for the equality of all
citizens and for nondiscrimination between men and women.
Not only have things changed for the better; changes are also
happening much faster than when today’s rich countries were
much poorer.
Chapter 2, by contrast, shows that things have not changed
for all women or in all aspects of gender equality. First, for poor
women and for women in poor places, sizable gender gaps remain, even in education enrollments and fertility, where global
progress has been great. For the wealthiest people across countries, there is little gender disadvantage, but it is large for severely
disadvantaged populations at the bottom of the income distribution. Ethnicity, distance, disability, or sexual orientation, among
other factors, further compound gender inequality. Second, in
some domains of gender equality there has been very little—or
very slow—change, even as countries get richer. These “sticky”
domains include excess female mortality in key periods of the
life cycle and occupational differences in the economic sphere.
In many areas of women’s agency, including political voice and
representation, differences between men and women remain entrenched, even in very rich countries and despite nearly a century
of women’s activism. Third, systemic shocks, such as droughts
or economic downturns, adversely affect males and females,
and their precise impacts depend on the context and the shock.
55

CHAPTER

1
A wave of progress

D

espite the hardships many women
endure in their daily lives, things
have changed for the better—and at
a speed that would not have been
expected even two decades ago. In four major
areas—women’s rights, education, health, and
labor force outcomes—the gains in the second
half of the 20th century were large and fast in
many parts of the world. Improvements that
took 100 years in wealthier countries took just
40 years in some low- and middle-income countries. Change has also been accelerating, with
gender equality gains in every decade building
on gains from the decade before.

TIMES ARE CHANGING?
This chapter traces where progress has been
made on gender equality and how. It starts with
the evolution of women’s rights and the fight
for equality under the law. Equality of rights
matters because a lack of rights can constrain
the choices available to women in many aspects
of life. Achieving them in today’s high-income
countries took considerable time. In contrast,
gains under the law have occurred much faster
in the developing countries, aided by a rising
global consensus supporting formal rights and
guarantees of equality for women.
In tandem with these gains in formal rights,
low- and middle-income countries have seen
unprecedented gains in outcomes for women,
both in absolute terms and relative to men. More
women are literate and educated than ever before, and the education gap with men has shrunk

“

Let our daughters go to school and
let them get good jobs. The moment
they will be independent from men in
thinking and earning, then they will
have very good lives.

”

Adult woman, Tanzania

dramatically. For younger cohorts, the gender
gap in primary education enrollments has practically disappeared, and the gains in secondary and higher education have been enormous.
Women are living longer and healthier lives in
much of the world, in part because lower fertility has reduced their risk in childbirth. And
they are participating more than ever in market
work. Economic growth has driven much of the
progress, through higher household incomes,
better service delivery, and new labor market opportunities for women. But it has not been the
only factor—the association between economic
growth and better outcomes for women has been
neither automatic nor uniform across countries.
Changes in one domain of gender equality
have fostered change in others, influencing the
next generation, reinforcing the whole process.
For example, the expansion of economic opportunities for women in service industries in
Bangladesh and India has boosted school enrollments for girls, which feeds into higher labor
force participation and better educational outcomes for the next generation.1
This is not to say that all problems have been
solved or that progress was easy. Indeed, chapter

A wave of progress

2 looks at countries and population groups with
continuing gender disadvantages as well as at
the many facets of life where gender imbalances
remain serious, even crippling. Delineating the
areas of change provides a foundation for understanding the constraints to gender equality—especially where they remain pervasive and
deep. And this understanding can help in setting
priorities for policy and public action.

RISING GLOBAL CONSENSUS
FOR WOMEN’S RIGHTS
The past three decades have seen great progress
in securing women’s formal rights and constitutional guarantees of equality. The Convention
on the Elimination of All Forms of Discrimination against Women (CEDAW), which the
United Nations General Assembly adopted in
1979, established a comprehensive framework
for the advancement of women. Ten years later,
almost 100 nations across all continents had ratified this international bill of rights for women.
And today, the number of signatories has almost
doubled, to 187 countries.
More than 30 years in the making, CEDAW
is the most widely supported international human rights treaty and the primary international
vehicle for monitoring and advocating gender
equality. Defining what constitutes discrimination against women and setting an agenda for national action, CEDAW is particularly concerned
with civil rights, the legal status of women, reproductive roles and rights, and the impact of
cultural factors on gender relations and on barriers to the advancement of women. It is the only
human rights treaty to explicitly address decisions about family planning and family formation. Countries ratifying CEDAW are required to
ensure that domestic legislation complies with it,

“

I know that [women] have many
rights: I can remember the right to
education, the prohibition of the
excision, and the prohibition to forced
marriage.

”

Adult woman, Burkina Faso

with progress monitored independently by the
Committee on the Elimination of Discrimination against Women.
Despite being known in the 1980s as the
“Cinderella treaty” for its vagueness of language
and weak monitoring and sanctions, CEDAW
has promoted legislative and administrative
change.2 In 1998, it influenced Turkey’s domestic violence act (Law No. 4320 Family Protection
Law). Turkey’s Constitutional Court also annulled requirements that husbands give permission for a wife’s professional activities, making
extensive references to CEDAW.3 Australia’s Sex
Discrimination Act 1984 draws on CEDAW to
prohibit discrimination in public life on the basis of sex, marital status, pregnancy, or potential
pregnancy.
In 2003, the African Union adopted the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa.
Better known as the Maputo Protocol, it asserts
women’s rights to take part in the political process, to enjoy social and political equality with
men, and to control their reproductive health.
Article 5 refers to the “elimination of harmful
practices,” including ending polygamous marriage and female genital cutting. Of 53 African
countries, 46 signed the protocol, and by February 2011, 30 countries had ratified it.4
Under the auspices of the Organization of
American States, all Latin American countries signed in 1994 the Belém do Pará InterAmerican Convention on the Prevention, Punishment and Eradication of Violence against
Women. Since then, 28 nations have enacted
laws with sanctions against domestic abuse.
These different international legal frameworks reflect the rising global consensus on
equal rights for men and women—a consensus
that did not emerge overnight but rather evolved
from a long, slow struggle for equal rights for
women that started in the advanced economies
as early as the 18th century and continued in developing countries in the second half of the 20th
century, reinforced by the emphasis on gender
equality in the Millennium Development Goals
(MDGs) (box 1.1).

Equal rights in the advanced
economies—A long time coming
Women’s circumstances in the 18th century were
very different than they are today. In 1789, the
French revolution asserted that men are “born

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WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

B OX 1.1

Gender and the Millennium Development Goals

The 2010 MDG Summit concluded with a global action plan to achieve the
eight MDGs by 2015. It also adopted a resolution calling for action to ensure
gender parity in education and health, economic opportunities, and decision
making at all levels through gender mainstreaming in the formulation and
implementation of development policies. The resolution and the action plan
reflect the belief of the international development community that gender
equality and women’s empowerment are development objectives in their own
right (MDG 3), as well as critical channels for the achievement of the other
MDGs. Gender equality and women’s empowerment help to promote universal
primary education (MDG 2), reduce under-five mortality (MDG 4), improve
maternal mortality (MDG 5), and reduce the likelihood of contracting HIV/AIDS
(MDG 6).
The 2010 resolution also stresses that achieving the MDGs will require coordinated interventions that target women and other vulnerable groups across
sectors:
•

•
•
•

Taking action to improve the number and active participation of women
in all political and economic decision-making processes, including investing in women’s leadership in local decision-making structures and creating
an even playing field for men and women in political and government
institutions
Expanding access to financial services for the poor, especially women
Investing in infrastructure and labor-saving technologies, especially in rural
areas, that benefit women and girls by reducing their domestic burdens
Promoting and protecting women’s equal access to housing, property, and
land, including rights to inheritance.

Source: WDR 2012 team.

and remain free and equal in rights” universally,
but the Declaration of the Rights of Man and of
the Citizen did not include women, and a year
later, the National Assembly chose not to extend
civil and political rights to women. The legal
system in the British colonies, based on English
common law, is another case. As Sir William
Blackstone summarized in his Commentaries on
the Laws of England in 1765:
By marriage, the husband and wife are
one person in law: that is, the very being
or legal existence of the woman is suspended during the marriage, or at least is
incorporated and consolidated into that
of the husband; under whose wing, protection, and cover, she performs everything; and is therefore called in our
law-french a femme-couvert. For this reason, a man cannot grant anything to his
wife, or enter into covenant with her: for
the grant would be to suppose her separate
existence.

The march toward equal property and suffrage rights has been slow and long. Only in
1857 did the British Parliament pass the Matrimonial Causes Act, allowing married women to
inherit property and take court action on their
own behalf. And not until 1882 did the Married
Women’s Property Act recognize a husband and
a wife as two separate legal entities, conferring
to wives the right to buy, own, and sell property
separately. Suffrage was not universal until 1928,
when, as a result of the Representation of the
People Act, women over age 21 received the vote
on equal terms as men. The story is similar in
Scandinavia: Norway, for example, provided full
economic rights to women in 1888 and suffrage
rights in 1913.
In the United States, New York was the first
state to pass, in 1848, a Married Women’s Property Act. Wives’ rights to earnings and property
gradually spread to other states over the following half century. Political voice was longer in
coming. A proposed constitutional amendment
guaranteeing women’s right to vote was introduced in the U.S. Senate in 1878, but it did not
receive a full vote until 1887, only to be voted
down. Three more decades elapsed before the
19th amendment to the constitution guaranteeing universal suffrage was ratified in 1920.
The struggle against discrimination in other
domains, such as labor and family law, picked
up momentum in the second half of the 20th
century.
In the United States, until the passage of Title
VII of the Civil Rights Act of 1964, women could
legally be passed over for promotions in the
workplace. Married women needed the consent
of their husbands to obtain a loan. And marital
rape was not recognized as a criminal act.5 Until
the 1980s, female flight attendants were required
to be single when they were hired and could be
fired if they married.
In Germany in the early 1950s, women
could be dismissed from the civil service when
they married. And through 1977, they officially
needed their husbands’ permission to work.
Until reunification with East Germany in 1990,
children of single mothers were assigned a legal
guardian.6
Japan’s Equal Employment Opportunity Act
of 1985 obliged employers merely to endeavor
to treat men and women equally during job
recruitment, assignment, and promotion. The
mandate for equal treatment came about in

A wave of progress

1997. The first domestic violence law was passed
in 2001.

Progress has been faster in low- and
middle-income countries
Progress has been most notable for political
rights, tied to a change in the concept of citizenship. National franchise movements gave
shape to a more inclusive paradigm of the
nation-state in the first half of the 20th century. Until then, citizenship had long been construed as “male.” Extending suffrage in already
established nation-states involved local social
movements and social networks redefining citizenship only after a lengthy renegotiation of domestic political power. In contrast, new nations
emerged into a “new world order.” National and
international organizations embraced a genderneutral model of citizenship, with women fully
accepted as persons capable of autonomous
decisions.7 Only three countries that became
independent in the 1900s (Austria, Ireland, and
Libya) extended suffrage to men before women.
But Switzerland did not break with tradition
and extend the franchise to women until 1971.
Among the latest countries to give women the
right to vote, Bhutan changed the practice of
casting one vote per household and adopted
women’s full suffrage in 2008. Today, only Saudi
Arabia restricts the franchise to men and removing this restriction for municipal elections
is under consideration.
Similar progress has been made in women’s
rights beyond full suffrage. In the Philippines,
sweeping legislative changes in the 1980s and
1990s recognized gender equality across a wide
array of domains. The 1987 constitution reinforced earlier constitutions by giving added
emphasis to the notion of gender equality. The
Comprehensive Agrarian Reform Law of 1988
assured equal rights to ownership of land. And
a 1989 act amended the Labor Code to protect
women from discrimination in hiring and pay.
Similarly, in 2004, Morocco overhauled its family code to promote greater equality between
women and men in multiple spheres.
The ratification of CEDAW and other international treaties established a comprehensive
framework to promote equality for women.
These treaties spurred further progress toward
securing formal rights in other domains of
women’s lives, in large part by facilitating new
legislation or promoting the repeal of discrimi-

natory legal provisions. In 2005, the Kenyan
Court of Appeal held that there was no reasonable basis for drawing a distinction between
sons and daughters in determining inheritance.
In 2001, the Tanzanian High Court held that a
widow is entitled to administer the estate on behalf of her children. In both cases, principles of
equality and nondiscrimination prevailed.

BETTER OUTCOMES FOR
WOMEN IN MANY DOMAINS
The march for women’s rights has gone hand in
hand with better outcomes for many women—
both in absolute terms and relative to men. During the past quarter century, sustained growth in
many countries has reduced disparities on some
dimensions of gender equality. And the pace of
change in these outcomes has been much faster
in today’s low- and middle-income countries
than it was in high-income countries. That can be
seen in indicators as varied as fertility, female education and literacy, and female labor force participation. In most countries where broad-based
income growth has combined with better institutions for service delivery and more economic
opportunities for women, the improvements in
these indicators have been dramatic—and in
some cases at rates never before witnessed.
Moreover, they occurred along some dimensions even in the face of social turmoil or significant institutional challenges. Consider Bangladesh, Colombia, and the Islamic Republic of
Iran.
Starting from a low base, the Bangladesh
economy has almost tripled since 1980. The
Bangladesh constitution, adopted in 1972, guaranteed equal rights to all citizens, regardless of
gender, religion, or other social divisions, and
reserved 15 parliamentary seats for women,
later increased to 30. In 1975, the government
reserved 10 percent of public jobs for women
and created a special Ministry of Women’s Affairs. Outcomes for women also improved dramatically on various fronts:
• From 1971 to 2009, the total fertility rate—
the number of children a woman is expected
to have through her reproductive years—declined from 6.9 children to 2.3.
• Between 1991 and 2005, the number of girls
in school increased from 1.1 million to 4 mil-

59

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WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

lion. Female enrollment climbed from 33 percent of the total to 56 percent, with somewhat
smaller increases among girls from the poorest two quintiles.
• The labor force participation of young women (ages 20–24) increased almost two and a
half times over 1995–2000. Although overall
labor force participation remains low, the
expansion of employment opportunities for
young women (linked to the growth of the
garment industry, health services, and social
work) has increased girls’ school enrollment
and lifted social restrictions on female mobility, allowing for a visible feminization of public spaces (chapter 6).8
The economy of Colombia, an upper-middleincome country in Latin America, has expanded
over one and a half times since 1980. Following
upheavals and a recession in 1999, it stabilized
after 2002. Colombia has also long been beset by
violence and the illegal drug trade. One remarkable feature is the improvement in women’s status in the past 25 years:
• From 1986 to 2005, the total fertility rate
dropped from 3.2 children to 2.4.
• Women reversed the education gap and now
have higher completion rates than men for
primary, secondary, and even tertiary education. The last is particularly striking given
that in 1984 almost twice as many men relative to women were college educated.
• In 1980, the labor force participation of Colombian females in the 13 largest cities was
the second lowest in the region (above only
Costa Rica), but by 2004, it was the second
highest, next to Uruguay. Remarkably, the
largest increases were among women with
children ages 0–6—women least likely to
work in most countries. And the representation of women is high in managerial positions and in finance—the glass ceilings notoriously hard to break in many advanced
economies.

“

The Islamic Republic of Iran’s economy has
almost doubled since 1980. And human development outcomes among Iranian women have
consistently improved along some key dimensions in the aftermath of the Islamic revolution:
• From 1979 to 2009, the Islamic Republic of
Iran saw the world’s fastest decline in fertility—from 6.9 children to 1.8 (below replacement).
• The female-to-male ratio in primary school
is the world’s highest, with 1.2 girls enrolled
for every boy. The number of women in secondary school as a percentage of the eligible
age group more than doubled from 30 percent to 81 percent, and in 2009, more than
half of all Iranian university students, 68 percent of the students in science, and 28 percent in engineering were women.
• Women make up 30 percent of the Iranian
labor force today, with the percentage of economically active women having increased
from 20 percent in 1986 to 31 percent in
2008.
Each of these three societies has faced some
circumstances commonly viewed as constraining gender equality. Yet in all of them, income
growth, better institutions for service delivery,
and new market opportunities for women have
contributed to greater gender equality in health,
education, and labor market outcomes even as
women in these countries continue to face significant challenges in other aspects of their lives.

More girls in school
More women are literate than ever before. Between 1950 and 2010, the average schooling for
women over age 15 in low-income countries increased from 1.5 years to 6.5. Compare that with
an increase from 2.6 years to 7.6 for men—and
with current averages in adult high-income populations of 10.9 years for women and 11.2 years
for men.9 Because the adult population includes
older people who do not increase their educa-

Child marriages have stopped. Girls are being sent to school. Even the poorest of us are
sending our daughters to school.

”

Adult man, India

61

A wave of progress

Gender parity in enrollments at lower levels has been achieved in much of the world, and
tertiary enrollments now favor women
Primary education
100

Some African
countries lag behind

school enrollment, girls, net, %

school enrollment, girls, net, %

100

80

60

40

20

0

20

40

60

80

60

40

20

girls
disadvantaged

0

100

0

school enrollment, boys, net %
East Asia and Pacific
South Asia

20

40

60

80

school enrollment, boys, net %

Europe and Central Asia

Sub-Saharan Africa

100

Enrollment gaps dwarf
gender gaps

80

girls
disadvantaged

0

Tertiary education

Secondary education

Latin America and the Caribbean

100

school enrollment, women, gross, %

F I G U R E 1.1

men
disadvantaged

80

60

40

Women are
more likely
to participate
than men

20

0
0

20

40

60

Middle East and North Africa

High-income countries

Source: WDR 2012 team estimates based on World Development Indicators.
Note: The 45° line in each ﬁgure above shows gender parity in enrollments. Any point above the 45° line implies that more women are enrolled relative to men.

tion, these rising averages reflect even greater
changes among young cohorts. In the United
States, it took 40 years, from 1870 to 1910, for
the share of 6–12-year-old girls in school to increase from 57 percent to 88 percent. Morocco
did the same in 11 years from 1997 to 2008.
These younger cohorts in all world regions
have experienced steady and sustained improvement toward greater gender equality in primary
education. In the past decade, female enrollments have grown faster than male enrollments
in the Middle East and North Africa, South Asia,
and Sub-Saharan Africa. Gender parity has been
reached in 117 of 173 countries with data (figure 1.1). Even in regions with the largest gender
gaps—South Asia and Sub-Saharan Africa (particularly West Africa)—gains have been considerable. In 2008, in Sub-Saharan Africa, there
were about 91 girls for every 100 boys in primary
school, up from 85 girls in 1999; in South Asia,
the ratio was 95 girls for every 100 boys.
The patterns are similar in secondary education, with one notable difference. In roughly
one-third of developing countries (45), girls
outnumbered boys in secondary education in
2008 (see figure 1.1). Although the female gender gap tends to be higher in poorer countries,

80

school enrollment, men, gross %

boys were in the minority in a wide range of nations including Bangladesh, Brazil, Honduras,
Lesotho, Malaysia, Mongolia, and South Africa.
Tertiary enrollment growth is stronger for
women than for men across the world. The
number of male tertiary students globally more
than quadrupled, from 17.7 million to 77.8
million between 1970 and 2008, but the number of female tertiary students rose more than
sevenfold, from 10.8 million to 80.9 million,
overtaking men. Female tertiary enrollment
rates in 2008 lagged behind in only 36 developing countries of 96 with data (see figure 1.1).
In Tunisia, 59 percent of the 351,000 students
enrolled in university in 2008 were women. As
chapter 6 shows, this increase in female enrollment is consistent with an increasing demand
for “brain” rather than “brawn” jobs in a globalizing world.
Although boys are more likely than girls to
be enrolled in primary school, girls make better
progress—lower repetition and lower dropout
rates—than boys in all developing regions.10
According to international standardized student achievement tests, girls tend to outperform
boys in language skills, while boys tend to have
a smaller advantage over girls in mathematics.

100

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WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

The 2009 Program for International Student
Assessment shows that 15-year-old girls in all
participating countries performed better than
boys in a reading test.
Economic growth has lowered the barriers
to school entry for millions of boys and girls
throughout the world and reduced gender inequality in schooling, particularly as countries
move from lower to middle and higher incomes.11 First, as countries prosper economically, the supply of services by government or
other service providers increases. Second, rising
incomes erode the need for families to differentiate educational investments across children,
on the basis of gender, birth order, or any other
reason, as they face less stringent budgets.12
Because more girls than boys had been out of
school, overall improvements in enrollments
tend to reduce gender differences. Third, as
growth opens new employment opportunities
for women in sectors that demand a certain level
of skills, such as light manufacturing or services,
incentives for parents to invest in their daughters’ education increases, because that education
now yields a greater return.
Eliminating school fees has had a similar effect in increasing overall enrollments and reducing gender differences. The free primary education programs across Sub-Saharan Africa have
had an overwhelming response. In their first
year, student enrollments climbed 68 percent in
Malawi and Uganda and 22 percent in Kenya.13
States have also mandated and enforced participation in schooling through compulsory education laws. Mass education systems expanded
quickly after World War II, and universal education laws can now be found in almost all nations.14 Such laws, usually combined with large
infrastructure and human resource investments
to enhance service delivery, have brought more
children into school throughout the world. In
1997, Turkey sought to increase educational
opportunities for children ages 11–13 years,
particularly rural girls, by expanding mandatory education from five years to eight. With the
launch of the Basic Education Program, enrollments jumped by 1.5 million children. Net enrollment rates, on the decline between 1991 and
1997, then rose from 86 percent in 1997 to 96
percent in 2002. Gains for rural girls were particularly impressive, jumping 160 percent in the
program’s first year alone in the nine provinces
(of 81) with the greatest gender disparity.15

Gender now explains very little of the remaining inequality in school enrollment (figure
1.2). In a large number of countries, a decomposition of school enrollments suggests that wealth
is the constraining factor for most, and in only
a very limited number will a narrow focus on
gender (rather than poverty) reduce inequalities
further (chapter 3).16

Healthier lives
The second half of the 20th century also saw
large improvements in men’s and women’s
health. Life expectancy at birth most clearly reflects improvements in health in populations
across the world. The average number of years
women could expect to live rose from 54 (51 for
men) in 1960 to 71 (67 for men) in 2008. This
period also saw the world’s fastest ever decline
in fertility—from an average of about 5 births
per woman in 1960 to 2.5 in 2008, lowering
the number of deaths associated with maternal
mortality. And bearing fewer children has given
women more time to invest in acquiring human
capital and to participate in market work.
In most world regions, life expectancy for
both men and women has consistently risen,
with women on average living longer than men.
The gap between male and female life expectancy, while still rising in some regions, stabilized
in others. On average, life expectancy at birth for
females in low-income countries rose from 48
years in 1960 to 69 years in 2008, and for males,
from 46 years to 65. Mirroring the worldwide increase in life expectancy, every region except SubSaharan Africa added between 20 and 25 years
of life between 1960 and today (figure 1.3). And
since 1980, every region has had a female advantage in life expectancy.
But there have been notable reversals. In
Eastern Europe and Central Asia, women’s advantage in life expectancy increased partly because of a sharp increase in male mortality,
with the differences apparently increasing over
time (see figure 1.3 for Ukraine). In some SubSaharan countries, the ravaging effects of AIDS,
especially for women, are evident. Since 1990,
gains in female life expectancy relative to men
have shrunk (see figure 1.3 for Botswana).
Increases in female life expectancy have been
driven in part by a significant decline in the risk
of mortality during one of the most dangerous
periods in a woman’s life—the early reproductive
years and the experience of childbirth. First, the

63

A wave of progress

F I G U R E 1.2

Gender explains little of the inequality in education participation for children
12–15 years old

contribution to total inequality, %

Low inequality

Moderate inequality

High inequality

100
80

60
40

20

gender

wealth

Turkey (2003)

Côte d’Ivoire (2005)

Chad (2004)

Benin (2006)

Niger (2006)

Mali (2006)

India (2005–06)

Guinea (2005)

Senegal (2008–09)

Sierra Leone (2009)

Ethiopia (2005)

Morocco (2003–04)

Burkina Faso (2003)

Liberia (2009)

Nigeria (2008)

Madagascar (2008–09)

Nepal (2006)

Lesotho (2009–10)

Cambodia (2005)

Congo, Dem. Rep. (2007)

Cameroon (2004)

Egypt, Arab Rep. (2008)

Mozambique (2003)

Bolivia (2008)

Colombia (2005)

Ghana (2008)

Peru (2004–08)

Malawi (2004)

Zimbabwe (2005–06)

Haiti (2005–06)

Vietnam (2002)

Tanzania (2007–08)

Azerbaijan (2006)

Zambia (2007)

Moldova (2005)

Maldives (2009)

Armenia (2005)

Namibia (2006–07)

Jordan (2009)

Ukraine (2007)

Guyana (2005)

Albania (2008–09)

Swaziland (2006–07)

Dominican Republic (2007)

Congo, Rep. (Brazzaville) (2009)

Kenya (2008–09)

Uganda (2009–10)

0

other factors

Source: WDR 2012 team estimates based on Demographic and Health Surveys.
Note: The measure of inequality refers to the percentage of total opportunities that must be reallocated to ensure that all the circumstances groups have the same average coverage rate. Low inequality is between 0.3 percent and 2.1 percent, moderate inequality is between 2.3 percent and 6.4 percent, and high inequality is between 6.5 percent and
26.7 percent. Results are sorted by size of gender contribution to total inequality.

risk of death per birth declined. During 1990–
2008, 147 countries experienced declines in the
maternal mortality ratio, 90 with a decline of 40
percent or more.17 The Middle East and North
Africa had the largest decline (59 percent), followed by East Asia and Pacific (56 percent) and
South Asia (53 percent). Second, the exposure to
the risk of death was lower because of dramatic
declines in fertility rates all over the world. With
women choosing to have fewer children, the
lifetime risk of death from maternal causes declined, even where the risk of death during each
birth changed little.
In most developing countries, fertility rates
fell sharply in a fairly short period. These declines were much faster than earlier declines in
today’s rich countries. In the United States, fertility rates fell gradually in the 1800s through
1940, increased during the baby boom, and
then leveled off at just above replacement. In
India, fertility was high and stable through 1960
and then sharply declined from 6 births per
woman to 2.3 by 2009. What took the United

States more than 100 years took India 40 (figure
1.4). Similarly, in Morocco, the fertility rate fell
from 4 children per woman to 2.5 between 1992
and 2004.
On various other aspects of health status and
health care, differences by sex are small. In many
low-income countries, the proportion of children stunted, wasted, or underweight remains
high, but girls are no worse off than boys. In fact,
data from the Demographic and Health Surveys
show that boys are at a slight disadvantage.18 In
Brazil, Côte d’Ivoire, and Vietnam, men’s and
women’s heights are increasing at almost identical rates, while in Ghana women’s heights have
increased more rapidly than those of men.19 In
many countries, children’s and adults’ anthropometric outcomes do not allow them to reach
their full potential, but an individual’s sex is not
the main culprit. North Indian states are a notable exception; women have grown taller at a
much slower rate than men, and girls’ anthropometric outcomes remain worse than boys—
both in levels and in changes over time.20

64

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

Women are living longer than men
East Asia and Pacific

Europe and Central Asia
80
life expectancy at birth

life expectancy at birth

80
70
60
50

70
60

men, Ukraine

50
40

40
1960

1970

1980 1990
years
women

2000

2010

1970

men

1980 1990
years
women

Middle East and North Africa

2000

1960

50
40

women

2000

women

2010

men

Sub-Saharan Africa

70
60
50

2010

1980 1990
years

80

40
2000

1970

men

life expectancy at birth

life expectancy at birth

60

1980 1990
years

50

South Asia

70

1970

60

2010

80

1960

70

40
1960

80
life expectancy at birth

Latin America and the Caribbean
80

women, Ukraine
life expectancy at birth

F I G U R E 1.3

70

women,
Botswana

60

men,
Botswana

50
40

1960

1970

men

1980 1990
years
women

2000

2010

men

1960

1970

1980 1990
years
women

2000

2010

men

Source: WDR 2012 team estimates based on World Development Indicators.

F I G U R E 1 .4

What took the United
States 100 years took
India 40 and the Islamic
Republic of Iran 10
How fast can fertility decline?

number of years for the total fertility
rate to fall from more than 6 children
to less than 3

Source: http://www.gapminder.org.

Similarly, there is little evidence of systematic
gender discrimination in the use of health services or in health spending. Out-of-pocket
spending on health in the 1990s was higher for
women than for men in Brazil, the Dominican
Republic, Paraguay, and Peru.21 Evidence from
South Africa reveals the same pro-female pattern,22 as does that for lower income countries.
In the Arab Republic of Egypt, more was spent
per capita on outpatient services for females (68
Egyptian pounds a year) than on male health
care (58).23 The gender difference in amounts
spent on inpatient services also favored females
but much less. In Ghana, females absorbed more
of a health subsidy than males did (56 percent
of overall health spending in 1992). Evidence
from India, Indonesia, and Kenya tells a similar
story.24
For preventive health services such as vaccination, poverty rather than gender appears to be
the major constraining factor (figure 1.5).25 As
with education enrollments, a decomposition

65

A wave of progress

FIGURE 1.5

Gender explains little of the inequality in use of preventive health services

contribution to total inequality, %

Low inequality

Moderate inequality

High inequality

100
80

60
40

20

gender

wealth

Haiti (2005–06)

India (2005–06)

Azerbaijan (2005)

Zimbabwe (2005–06)

Madagascar (2008-09)

Benin (2006)

Liberia (2009)

Ethiopia (2005)

Mozambique (2003)

Turkey (2003)

Congo, Rep. (Brazzaville) (2009)

Niger (2006)

Guinea (2005)

Congo, Dem. Rep. (2007)

Nigeria (2008)

Armenia (2005)

Mali (2006)

Nepal (2006)

Modova (2005)

Burkina Faso (2003)

Dominican Rep. (2007)

Peru (2004–08)

Lesotho (2009–10)

Kenya (2008–09)

Namibia (2006–07)

Colomba (2005)

Cameroon (2004)

Swaziland (2006–07)

Malawi (2004)

Philippines (2008)

Indonesia (2007)

Cambodia (2005)

Albania (2008–09)

Ghana (2008)

Jordan (2009)

Zambia (2007)

Uganda (2009–10)

Morocco (2003–04)

Sierra Leone (2008)

Bolivia (2008)

Rwanda (2007)

Maldives (2009)

Honduras (2005–06)

Egypt, Arab Rep. (2008)

Senegal (2008–09)

Bangladesh (2007)

0

other factors

Source: WDR 2012 team estimates based on Demographic and Health Surveys.
Note: The measure of inequality refers to the percentage of total opportunities that must be reallocated to ensure that all the circumstances groups have the same average coverage rate. Low inequality is between 1.0 percent and 3.2 percent, moderate inequality is between 3.4 percent and 5.2 percent, and high inequality is between 5.2 percent and
22.0 percent. Results are sorted by size of gender contribution to total inequality.

suggests that only a handful of countries have
high inequality in measles vaccinations (other
vaccines are even more universal) and where
gender is a major contributing circumstance.

More women participate in market work
Female labor force participation has grown since
1960, dramatically in some regions. Expanding
economic opportunities have drawn large numbers of new female workers into the market. Between 1980 and 2008, the global rate of female
labor force participation increased from 50.2
to 51.8 percent while the male rate fell slightly
from 82.0 to 77.7 percent. So the gender gap
narrowed from 32 percentage points in 1980 to
26 percentage points in 2008 (figure 1.6).26
Driving the convergence across countries
are large increases in participation in countries that started with very low rates (primarily
in Latin American and the Caribbean and in
the Middle East and North Africa) combined
with small declines in countries that started
with very high rates (primarily in Eastern Europe and Central Asia). Participation rates now
exceed 50 percent in Sub-Saharan Africa, East

Asia and the Pacific, Europe and Central Asia,
and Latin America and the Caribbean, while
more than 60 percent of women remain economically inactive in South Asia and the Middle East and North Africa.
Labor force participation increased markedly
for women with more education, but declined
among women ages 15–24, who have remained
in school longer, slowing the growth in overall
participation since 1990.
Around the world, for very poor countries,
female labor force participation is high, reflecting a large labor-intensive agricultural sector
and significant numbers of poor households.27
In this situation, women are willing to enter
the labor force even at fairly low wages because
unearned incomes are also low. As per capita
incomes rise, unearned income rises (through
higher male wages and earnings), and these
higher incomes are typically associated with
women withdrawing from the labor market.
Social barriers against women entering the paid
labor force also regain prominence, and their
participation rates fall. But as countries continue to develop, further increases in women’s

66

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

F I G U R E 1.6

The gender gap in labor force participation
narrowed between 1980 and 2008

East Asia and Pacific
Europe and Central Asia
Latin America and the Caribbean
Middle East and North Africa

Source: WDR 2012 team estimates based on International Labour Organization 2010.
Note: The 45° line in the ﬁgure above shows parity in the values on the vertical and horizontal axis.

female labor force participation rate, %

F I G U R E 1.7

Across countries, at every income level, female
labor force participation increased between
1980 and 2008

CHANGE BEGETS CHANGE

80

2008

70

60

50

1980

40
4

6

8

10

estimated on the basis of data from 130 countries around 1980 and 2008, highlights these
two features (figure 1.7). First, there is a clear
U-shape relationship across countries at different incomes for both periods. Second, the participation rate associated with each level of development increases over time—the U-shaped
curve moves upward as time passes. So at each
level of income, more women were participating
in market work in 2008 than in 1980.
Changes in education and family structure have also driven women’s employment
over time. Delays in the timing of marriage
and childbearing as well as lower fertility have
brought more women into the labor market,
ranging from as little as 7 percent in Bolivia
to about 30 percent in Argentina and Colombia, and contributing an average of 21 percent
overall to the rise in female labor force participation across 10 Latin American countries.
An additional 42 percent of the rise in female
labor force participation in Latin America can
be attributed to more education—in Panama,
education accounts for as much as 81 percent.
Urbanization, household technology, and the
sectoral structure of the economy appear to
matter much less in bringing women into the
labor force.28

12

log, GDP per capita (constant 2000 US$)

Source: WDR 2012 team estimates based on International Labour Organization 2010.

education and wages move them back into the
labor market.
The relationship between economic development and female labor force participation,

A notable transformation has taken place
around the world with impressive gains in
women’s rights, educational attainment, health
outcomes, and labor force participation. Positive
feedback loops between gains in these different
areas explain why change has been so quick in
the developing world.
Improvements in one area (higher education) can drive changes in other areas (such as
lower fertility and higher labor force participation). Similarly, better labor opportunities can
in turn induce more investments in education
and in women’s health for the next generation,
while equal rights can underpin progress on all
fronts. Conversely, a lack of improvement in, say,
rights can hold back improvements in women’s
access to market work, and failures to redress
gender gaps can impair a whole range of health
outcomes for women. Understanding these
feedback loops is important for policy design.
So is understanding the constraints to progress,
and whether they are rooted in what happens in

A wave of progress

households, in how markets operate, or in institutions (formal and informal).

New labor market opportunities can
spur investments in education and health
for girls
How much parents invest in their children’s
education is partly determined by the returns to
that education. Early studies showed that new
agricultural technologies that favored women’s
production increased girls’ enrollment.29 A new
generation of studies extends these insights in a
globalizing economy.
For instance, the rise of outsourcing in India offers new opportunities for women in the
wage sector and increases parental investments
in girls’ education.30 Recruitment services that
informed families about new employment opportunities for Indian women increased the
chances of girls ages 5–15 years to be in school
by 3 to 5 percentage points but had no effect on
boys.31 The girls also had higher body mass index (a measure of health) and were 10 percent
more likely to be employed in wage work. Perceived improvements in the likelihood of a job
triggered investments in human capital for girls
even when there were no changes in other potential limiting factors, such as poverty, cost, or
distance to school. Evidence of greater returns
was enough to stimulate greater human capital
accumulation.
It has often been posited that cultural and
social norms (or “informal institutions” in the
Report’s framework) “hold back” human capital investments. So, many policy efforts try to
change the status quo by trying to nudge norms.
The results here present an alternative route—
expand economic opportunities, and human
capital investments in girls will increase. Markets can affect private household decisions, even
with slow-moving social norms.

Investing in the future
A similar consideration—linking parental investments in education and returns down the
line—underpins the relationship between health
and schooling. At its starkest, lowering the risk
of death should lead to greater human capital
accumulation during childhood. Put simply, the
longer you get a payout from your investment,
the more attractive it is to make that investment.
If the risk of dying from childbirth is high, parents factor in this risk and reduce investments
in daughters.

Perhaps the clearest demonstration of the
link comes from declines in maternal mortality. Life expectancy rose sharply in Sri Lanka
between 1946 and 1953 as a result of declines
in maternal mortality ratios, from 180 per 1,000
live births to 50. Given that women had 5 children on average, 1 in 10 women died giving
birth before these declines—a huge risk. Using
variation in the timing of the declines in different parts of the country, one study shows that
the overall declines in maternal mortality ratio boosted female life expectancy by 1.5 years,
female literacy by 1 percentage point, and female
education by 0.17 years.32
Given that a reduction in the maternal mortality ratio also reduces maternal morbidity, it
increases the ability of women to participate in
the labor force. Evidence from the United States
shows that in 1920 one in six women suffered
from a long-term disability incurred in childbirth. A sharp decline in maternal mortality
resulting from the discovery of sulfa drugs in
1936 (and their immediate widespread use)
went hand in hand with dramatic improvements in health for women after childbirth.
Improvements in the conditions of childbirth
were the biggest force behind the rise in married
women’s labor force participation in the United
States between 1920 and 1950.33
Who would have thought that the fastest
way to increase female labor force participation in the United States at the beginning of
the 20th century would be to reduce maternal
mortality? Households, markets, social norms,
and formal institutions are inextricably connected, and the key is to find ways to stimulate
progress in all domains. For reducing maternal mortality, chapter 3 shows that income or
household actions are less powerful than effective institutions—and public investments are
critical.

“

What are your hopes for your daughter’s future?
She must be bright and intelligent, educated,
and look after this community. For my sons,
they must be educated to take ownership of land,
build permanent houses, and develop
this community.

”

Adult woman, Papua New Guinea

67

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

Choosing differently
Recent findings suggest that women’s rights and
agency play a role seeing that those public investments are made. In a world where women care
about different things from men (and women
do appear to care for children more than men
do), it may be that when women have more
voice, they can drive institutional investments
in a way that favors children. So, when women
have more rights in the political arena, does the
nature of public investment change? Yes.
Recall that in the United States women won
voting rights state by state over the 19th century
until they were federally mandated by constitutional amendment in 1920. Public health spending increased dramatically as women won the
right to vote. The Sheppard-Towner Maternity
and Infancy Protection Act of 1921 provided
federal funding for maternity and child care.
According to one observer,
Indeed, fear of being punished at the polls
by American women, not conviction of the
bill’s necessity, seems to have motivated
Congress to vote for it. As one senator admitted to a reporter from the Ladies Home
Journal, if the members of Congress could

F I G U R E 1 .8

Who agrees that a
university education
is more important for a
boy than for a girl?

have voted on the measure in their cloak
rooms, it would have been killed as emphatically as it was finally passed out in
the open. 34
Growth in public spending led to the scaling up of intensive door-to-door hygiene campaigns and to a sharp decline in child mortality
by 8 to 15 percent. Roughly 20,000 child deaths
were averted every year because women won the
right to vote. A variant of these broad results
has also been documented in Switzerland, with
the additional twist that women seem to have
become more supportive of health and welfare
expenditures over time than men.35 For Europe,
the results suggest that female suffrage increased
spending on health, education, and welfare expenditures over time.36

Intergenerational cycles
The links across sectors also play out over time.
Recent studies show that, in England and the
United States, more maternal education leads to
a host of better outcomes for children—better
education and better health. For children ages
7–8, an additional year of mother’s schooling
increases the child’s performance on a standard-

Source: WDR 2012 team estimates based on World Values Surveys,
1994–99 and 2005–07 waves.

Source: WDR 2012 team estimates based on World Values Surveys,
1994–99 and 2005–07 waves.

Note: The 45° line in the ﬁgure above shows parity in the values on
the vertical and horizontal axis.

Note: The 45° line in the ﬁgure above shows parity in the values on
the vertical and horizontal axis.

A wave of progress

ized math test and reduces the incidence of behavioral problems.37 Similar results document
the link between maternal education and child
education in low-income countries, where even
a single year of maternal education can make
a large difference. Children of mothers with a
single year of education in Pakistan spent an additional hour every day studying at home and
reported higher test scores.38
The intergenerational impact of female education is not restricted to the home. Contemporaneous and intertemporal links came together
in the rise of private schooling in Pakistan,
which exploded after 1990.39 A curious feature
of the expansion was that these private schools
were overwhelmingly located in villages where a
public girls’ secondary school had existed a decade earlier. By establishing secondary schools
for girls in rural areas, the government created
a cohort of teachers who could then teach children at the primary level in the next generation.
The students of today became the teachers of tomorrow. An institutional improvement (public
secondary schools for girls) enabled a household
response (more girls with secondary education)
that then played out in a change in the market
(private schools and more female employment
opportunities) one generation later.

Changes in attitudes
Upholding rights also has a ripple effect in social mores and attitudes. The World Values Survey provides a window on how social perceptions have shifted. Traditionally, social attitudes
toward women have given primacy to their domestic roles as mothers and homemakers. Progressively, social norms appear to be shifting to
be more accepting of women as social actors—
across a large number of countries with data,
even if significant differences remain across
countries.
Women are increasingly considered to have
equal standing with men in access to tertiary
education and participation in the labor force.
In most countries with data, there has been a
significant reduction in the share of people who
believe that “university is more important for
men than for women” and “men should have
more right to a job than women when jobs are
scarce” (figures 1.8 and 1.9). In Turkey, the share
of individuals concurring that higher education
is preferable for men fell from 34 to 20 percent
in 10 years.

hings have changed for the better, but
not for all women and not in all domains of gender equality. Progress has
been slow and limited for women in
very poor countries, for those who are poor,
even amid greater wealth, and for those who face
other forms of exclusion because of their caste,
disability, location, ethnicity, or sexual orientation. Whether for comparisons between men
and women in the same country, or absolute
comparisons of women across countries, the
progress in some domains is tempered by the sobering realities that many women face in others.
Consider the likelihood of women dying during childbirth in Sub-Saharan Africa, which is
still comparable to the rate in Northern Europe
during the 19th century. Or the difference in
school enrollments in Nigeria, where a wealthy
urban child averages around 10 years of schooling, while poor rural Hausa girls average less
than 6 months.1 Or the fact that women remain
severely disadvantaged in their control over resources and assets in the household. Or that the
earnings differentials between men and women
have not changed much. Or that women’s rep-

“

“

We are not educated. We don’t
know anything and do not know
how we can be able to change
our life and obtain power and
freedom.

”

Adult woman, rural Afghanistan

resentation in policy making remains far lower
than men’s. Or that domestic violence continues to exact a heavy toll on women around the
world—regardless of individual or country income, women continue to be the primary victims of violence at home and to suffer more
severe injuries.
Where is progress absent?
• Severely disadvantaged populations. Across
and within countries, gender gaps widen at
lower incomes, and, in the poorest economies,
gender gaps are larger. The benefits of eco-

There is no such thing as equality between men and women in this community,
maybe in towns and urban areas, but not here! A man is always above
the woman.
Adult man, rural South Africa

Women just started entering society, so the man is still trying to maintain
his control.

”

Adult man, West Bank and Gaza

The persistence of gender inequality

While much of the world has reduced gender
gaps in health and education, conditions for
women in some low-income countries have not
improved much. In many South Asian and SubSaharan countries, girls’ enrollments in primary
and secondary education have progressed little.
In Eritrea, the female primary net enrollment
rate rose from a very low base of 16 percent in
1990 to just 36 percent in 2008. In Afghanistan,
Chad, and the Central African Republic, there
are fewer than 70 girls per 100 boys in primary

Young woman, Serbia

school. The Republic of Yemen has one of the
world’s largest gender disparities in net enrollment rates, and progress has been difficult to
sustain.2 School enrollments for girls 5–19 years
old in Mali are equivalent to those in the United
States around 1810 (figure 2.1).
Gender disparities have also lingered among
groups that have not benefited from growth
within countries: income poverty widens gender gaps. While the educational attainment of

FIGURE 2.1

Female enrollments remain strikingly low in some
countries

50
40
30

Mali
Ethiopia

Nigeria

60

Côte d’Ivoire

70

Mozambique

80

Niger

90

20

Tajikistan
Bangladesh
Egypt, Arab Rep.

100

Pakistan

SEVERELY DISADVANTAGED
POPULATIONS

”

Burkina Faso

• Reversals. External shocks—sometimes economic, sometimes political, sometimes institutional—can erase hard-earned gains. In
some instances, improvements in gender
equality have been reversed in the face of unexpected shocks that revealed or worsened
institutional or market failures. The shocks
affect both males and females, but multiple
factors shape their impact on gender differentials—among them, the source and type of
shock, economic and institutional structures,
and social norms. Even when shocks do not
have differential gender impacts, the absolute
welfare losses for both men (and boys) and
women (and girls) can be substantial. In particular, adverse circumstances early in life, as
in the critical first three years, can have irreversible long-term effects.

Money. And someone who would
convince my dad to let me continue
my education. . . . If I had enough
money, I would enroll somewhere as a
part-time student. You have to pay for
every exam.

• “Sticky” domains. Improvements in some domains of gender equality—such as those related to occupational differences or participation in policy making—are bound by
constraints that do not shift with economic
growth and development. Gender disparities
endure even in high-income economies despite the large gains in women’s civil and
economic rights in the past century. These
outcomes are the result of slow-moving institutional dynamics and deep structural factors that growth alone cannot address.

“

female school enrollment, ages 5–19, (%)

nomic growth have not accrued equally to all
men and all women for some parts of society.
Household poverty can mute the impact of
national development, and the differences are
often compounded by other means of social
exclusion, such as geography and ethnicity.

73

year
United States
trend line (United States, 1850–2000)
Source: WDR 2012 team estimates based on U.S. Census and the International Income Distribution Database (I2D2).
Note: Values between 1760 and 1840 are based on female school enrollment trending between 1850 and
2000.

wealthy boys and girls is very similar, gender
inequalities are intensified among the poor. In
India, the median boy and girl ages 15–19 in the
wealthiest fifth of the population reach grade 10,
but the median boy in the bottom fifth reaches
only grade 6, and the median girl only grade 1.
Across countries there is little gender disadvantage for the wealthiest: households in the top income quintile tend to achieve full gender parity
in education.
Poor girls face a significant schooling disadvantage in much of Africa and South Asia, a
disadvantage that increases at lower incomes, as
in Benin, the Democratic Republic of Congo,
The Gambia, and Togo (figure 2.2). Yet the
opposite can be observed elsewhere—in Bangladesh, Brazil, the Dominican Republic, the
Philippines, and the República Bolivariana de
Venezuela, girls at low levels of wealth tend to
stay longer in school than boys (figure 2.3). Regardless of whether the gender gap favors boys
or girls at low household incomes, in countries
where the difference between rich and poor

tends to be small—as in Uzbekistan or Vietnam—gender differences also tend to be small.
The disadvantage for girls tends to be more
pronounced and to emerge earlier than for boys.
A girl in the poorest fifth of the population in
the Democratic Republic of Congo studies three
fewer years than a poor boy. And a cumulative
gender bias against girls builds over the educational life cycle. In 2008, there were only 66
female tertiary students for every 100 male students in Sub-Saharan Africa and 76 in South
Asia.3 Sub-Saharan Africa is the only region
where growth in male tertiary enrollment has
outpaced female enrollment growth, especially
for doctoral degrees.
The gaps between rich and poor are the same
in health. Lower fertility rates imply that fewer
women are exposed to the risk of childbirth,
and reductions in parity (the number of times
a woman has given birth) and the age-structure
of births have accounted for a sizable fraction
of declines in the lifetime risk of death from
maternal causes.4 Although fertility rates have

75

The persistence of gender inequality

F I G U R E 2.3

… yet in others, at low levels of wealth girls stay longer in school than boys
Bangladesh

Brazil

6
4

10
median grade attained,
ages 15–19

median grade attained,
ages 15–19

median grade attained,
ages 15–19

8

2

8
6
4
2

1

2

3

4

5

8
6
4
2

1

2

income quintile

3

4

5

1

income quintile

Philippines
median grade attained,
ages 15–19

10

8
6
4
2

8
6
4
2

1

2

3

4

5

income quintile

1

2

3

4

5

income quintile
girls

boys

Source: WDR 2012 team estimates based on EdAttain.

dropped dramatically in all regions since 1960,
they have been rising in many Sub-Saharan
countries. In Nigeria, the total fertility rate rose
from 4.7 children in 1999 to 5.7 in 2008.5
As in education, household wealth makes a
difference. In all countries, fertility rates for the
poor are higher than for the rich (figure 2.4).
Yet at low fertility (typically in richer countries), the differences between the bottom and
the top quintiles tend to be small—on the order
of 0.5 to 1 live birth. At higher fertility (usually
in poor countries), the differences widen. In
Zambia, the average fertility of a woman in the
poorest quintile is 8.5 children (the highest in
the world), but for a woman in the richest fifth,
it is just over 3.
In addition to household wealth, ethnicity
and geography are important for understanding and addressing gender inequality. Even in
countries that have grown rapidly, poor and
ethnic minority women tend to benefit far less
than their richer and ethnic majority counterparts. So, wide gender disparities endure. Many

2

3
income quintile

Venezuela, RB

10
median grade attained,
ages 15–19

Dominican Republic

10

10

ethnic minorities are poorer and less urban than
the general population. An estimated two-thirds
of girls out of school globally belong to ethnic
minorities in their countries.6 In Guatemala, the
illiteracy rate among indigenous women stands
at 60 percent, 20 percentage points above indigenous males and twice that of nonindigenous females.7 For ethnic minorities in Vietnam, more
than 60 percent of childbirths take place without prenatal care, twice the rate for the majority
Kinh. More urban ethnic minority groups and
groups not concentrated in poor regions tend to
experience smaller differences with the majority populations. In China, rural ethnic minority
groups have less access to education and health
than the more urban Han, Hui, and Manchu,
but the school enrollment and health insurance
gaps narrow in urban areas.8
Other factors of exclusion, such as caste, disability, or sexual orientation, also tend to compound disadvantages in ways that affect development outcomes. More research is needed to
better understand these links.

4

5

76

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

F I G U R E 2.4

At low incomes, fertility rates remain high—And
the poorer the country, the larger the gap between
rich and poor

Zambia: Women in
the poorest quintile
bear more than
8 children on
average; whereas
in the richest
quintile, the
average drops
to 3.5 children.

⽧

⽧
⽧
⽧

⽧
⽧
⽧

⽧
⽧
⽧
⽧
⽧
⽧
⽧
⽧
⽧
⽧
⽧
⽧
⽧
⽧
0

1

2

⽧
⽧

3

⽧

⽧

⽧
⽧
⽧

⽧
⽧

⽧
⽧
⽧
⽧
⽧
⽧
⽧
⽧
⽧

⽧

⽧

⽧
⽧

4

5

6

7

8

average number of children
richest quintile
fertility rate

average
fertility rate

⽧
poorest quintile
fertility rate

Source: WDR 2012 team estimates based on Demographic and Health Surveys.

“STICKY” DOMAINS, DESPITE
ECONOMIC PROGRESS
In two areas, income growth has brought only
modest and gradual progress toward gender
equality in most developing countries: female
mortality and access to economic opportunities.
And gender gaps have not narrowed in women’s

control over resources, women’s political voice,
or the incidence of domestic violence.
In some cases, individual preferences, market failures, institutional constraints, and social norms continue to reinforce gender gaps
despite economic progress. Income growth
may also have unexpected adverse effects on
gender equality through new gendered preferences. In other cases, development outcomes
have not always reflected extensive formal
gains in securing equal rights. Despite notable
improvement in expanding legal guarantees to
women and men alike, slow implementation
has impeded a move into gender parity. Social
norms continue to bind to varying degrees in
all nations, and a chasm remains between theory and practice.
Economic growth can even temporarily aggravate gender differentials in some countries.
In China, new opportunities for rural industrial
wage work led families initially to favor the junior secondary education of males, considerably
widening the gender gap in the 1980s.9 But as
the economy continued to grow, girls rapidly
caught up with boys in the 1990s. Sub-Saharan
Africa is in the midst of a significant expansion
of secondary education. As in China, more African boys than girls attended secondary school
between 1999 and 2008, deepening the gender
gaps. In 2008, there were 79 girls for every 100
boys, down from 83 girls per 100 boys in 1999.
Indeed, girls face significant barriers to secondary school entry, but enrollment rates tend to be
low all around.
In some cases, these gaps work against boys.
Everywhere in the world, repetition and, to a
lesser extent, dropout rates are higher among
boys than among girls. Some upper-middleincome and advanced economies are concerned
about male underachievement in education—
girls outperforming boys academically. In the
United States and Israel, girls obtain better grades
in all major school subjects, including math and
science.10 In France, women are the majority in
enrollments at the elite Grandes Ecoles de Commerce (business schools).11 Male underperformance in higher education usually is not rooted
in social exclusion, but men can also be subject
to cultural norms that steer them away from
academic achievement. Identifying education as
primarily a “female” endeavor means that young
men in several Caribbean nations, such as Dominica and Jamaica, withdraw from school.12

77

The persistence of gender inequality

Missing girls at birth and excess
female mortality
Sex ratios at birth and mortality across countries in 1990, 2000, and 2008 reveal continuing
disadvantages for women in many low- and
middle-income countries (and disadvantages
for men in some regions for specific reasons).
First, the problem of skewed sex-ratios at
birth in China and India (and in some countries in the Caucasus and the Western Balkans) remains unresolved (table 2.1). Population estimates suggest that an additional 1.4
million girls would have been born (mostly in
China and India) if sex ratios at birth in these
countries resembled those found worldwide.
Second, compared with developed economies,
the rate at which women die relative to men in
low- and middle-income countries is higher
in many regions of the world.13 Overall, missing girls at birth and excess female mortality
under age 60 totaled an estimated 3.9 million
women in 2008—85 percent of them were

TA B L E 2.1

“ ”

My sister gave birth when she was 14
and died.
Young woman, the Republic of Yemen

in China, India, and Sub-Saharan Africa. In
other countries—notably some post-transition economies—excess male mortality has
become serious.
Over the past three decades, some aspects
of the problem remained the same, while others changed dramatically. Skewed sex ratios at
birth were identified in the early 1990s,14 and
as prenatal sex determination spreads and fertility declines, the problem has become worse.
Excess female mortality is slowly shifting from
early childhood in South Asia to adulthood in
Sub-Saharan Africa, declining in all low-income
countries except in Sub-Saharan Africa (see
chapter 3).

Missing girls at birth increased between 1990 and 2008 in India and China, as did excess
female mortality in adulthood in Sub-Saharan Africa
Excess female deaths in the world, by age and region, 1990 and 2008
(thousands)

Total
women
girls at birth

girls under 5

2008

1990

women 15–49

2008

1990

women 50–59

2008

China

890

1,092

259

71

21

5

208

56

92

India

265

257

428

251

94

45

388

228

81

42

53

183

203

61

77

302

751

50

High HIV-prevalence countries

0

0

6

39

5

18

38

328

Low HIV-prevalence countries

Sub-Saharan Africa

1990

girls 5–14

1990

2008

1990

under 60

2008

1990

2008

30

1,470

1,254

75

1,255

856

99

639

1,182

4

31

53

416

42

53

177

163

57

59

264

423

46

68

586

766

South Asia (excluding India)

0

1

99

72

32

20

176

161

37

51

346

305

East Asia and Pacific (excluding China)

3

4

14

7

14

9

137

113

48

46

216

179

Middle East and North Africa

5

6

13

7

4

1

43

24

15

15

80

52

Europe and Central Asia

7

14

3

1

0

0

12

4

4

3

27

23

Latin America and the Caribbean

0

0

11

5

3

1

20

10

17

17

51

33

1,212

1,427

1,010

617

230

158

1,286

1,347

343

334

4,082

3,882

Total

Source: WDR 2012 team estimates based on World Health Organization 2010 and United Nations Department of Economic and Social Aﬀairs 2009.
Note: Totals do not necessarily add up because of rounding.

78

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

F I G U R E 2.5

Maternal mortality in many developing countries
is similar to that in Sweden before 1900

Source: WDR 2012 team estimates based on World Health Organization and others 2010.

What accounts for these patterns? Chapter 3
provides a deeper discussion, but two issues are
highlighted here: maternal mortality and the
preference for sons. The female disadvantage in
mortality during the reproductive ages is in part
driven by the risk of death in pregnancy and
childbirth and associated long-term disabilities.15
Although maternal mortality ratios have fallen
by 34 percent since 1990, they remain high in
many parts of the world: Sub-Saharan Africa had
the highest ratio in 2008 at 640 maternal deaths
per 100,000 live births, followed by South Asia
(280), Oceania (230), and Southeast Asia (160).16
Bangladesh, Cambodia, India, and Indonesia
have maternal mortality ratios comparable to
Sweden’s around 1900, and Afghanistan’s is similar to Sweden’s in the 17th century (figure 2.5).
These high mortality ratios translate into
large absolute numbers of maternal deaths, especially where fertility rates remain high. In
2008, there were 63,000 maternal deaths in India
and 203,000 (more than half of the total) in SubSaharan Africa, in stark contrast to rich coun-

tries, with only 1,900 maternal deaths.17 One of
every 10 women in Afghanistan and 1 of every
14 in Somalia and Chad die from maternal
causes, and a much larger fraction suffer longterm health issues stemming from complications during and after childbirth.
Progress in maternal mortality has not kept
up with GDP growth. During 2000–08, the economies of Chad and Tanzania grew at impressive
annual rates of 9.4 percent and 7 percent, but
maternal mortality declined by a mere 8 percent
(to 1,200 per 100,000 live births) in Chad and
by 14 percent (to 790) in Tanzania. South Africa
grew at a modest 4 percent annually during the
same period, and maternal mortality increased
by 8 percent to 410 per 100,000 births—a manifestation of the HIV/AIDS epidemic. Since 1990,
both India and Equatorial Guinea had declines
of 41 percent in their maternal mortality ratios,
which fell to similar levels in 2008, but the two
countries had radically different growth trajectories—a mere 3 percent a year in Equatorial
Guinea compared with a solid 8 percent in India. Driving the high maternal mortality rates
in many countries are poor obstetric health services and high fertility rates. Income growth and
changes in household behavior alone appear
insufficient to reduce maternal mortality; public investments are key to improving maternal
health care services.
The disadvantage against unborn girls is
widespread in many parts of Asia and in some
countries in the Caucasus (such as Armenia and
Azerbaijan), where the intersection of a preference for sons, declining fertility, and new technology increases the missing girls at birth. In
China and India, sex ratios at birth point to a
heavily skewed pattern in favor of boys. Where
parents continue to favor sons over daughters,
a gender bias in sex-selective abortions, female
infanticide, and neglect is believed to account
for millions of missing girls at birth. In 2008
alone, an estimated 1 million girls in China and
250,000 girls in India were missing at birth.18
The abuse of new technologies for sex-selective
abortions—such as cheap mobile ultrasound
clinics—accounted for much of this shortfall,
despite laws against such practices in many
nations, such as India and China.19 Economic
prosperity will continue to increase amniocentesis and ultrasound services throughout the developing world, possibly enabling the diffusion
of sex-selective abortions where son-preferences
exist.20

The persistence of gender inequality

These preferences do not appear to change
easily. Even among later children of South and
Southeast Asian immigrants in Canada, the
United Kingdom, and the United States, the
share of male births remains unusually high.21
This does not imply that change is impossible: The Republic of Korea’s male-female sex
ratio under age five was once the highest in
Asia, but it peaked in the mid-1990s and then
reversed—a link to societal shifts in normative
values stemming from industrialization and
urbanization.22
In a smaller set of countries, there are also
missing men. In Eritrea in the 1990s, a large
number of young men went missing due to conflict. In some countries in Latin America and the
Caribbean, violence may have contributed to excess deaths among young males. In Eastern Europe and Central Asia, a much larger number of
men are missing in middle age, and this excess
male mortality has been linked to the prevalence of types of conduct deemed more socially
acceptable among men, such as alcohol use and
other risky behavior.

Men and women are not paid the
same daily wages. If men get Nu 200,
then women get only Nu 150 for
doing the same work. It is not fair or
just.

”

Adult woman, Bhutan

Different work, less pay
Men and women work in different industries
and occupations in developed and developing
nations. But as chapter 1 showed, although more
women are working outside the home in almost
all countries, they are clustered into selected
parts of the “economic space,” with little change
over time, even in high-income countries. Three
markers of the segregated workspace are particularly striking. First, women are more likely to
engage in low productivity activities than men
and to work in the informal sector (figure 2.6).
Women are more likely to be wage workers and
unpaid family workers than men, to have less
mobility between the formal and informal sectors, and to transition more between the informal sector and being out of the labor force.23
Second, among the self-employed, women
outside agriculture tend to operate small in-

men

Source: WDR 2012 team estimates based on International Labour
Organization 2010.
Note: Most recent year available between 1999 and 2006.

formal businesses, often out of their homes. Of
industrial homeworkers in some developing
countries, such as Chile and Thailand, 80 percent are women.24 Because of the nature of these
businesses, female owners are concentrated in
the smallest firms—smaller in employees, sales,
costs, and the value of physical capital. They also
have lower profits than male-owned firms. In
Latin America, average profits are between 15
and 20 percent of a standard deviation lower for
female than for male-owned firms.25
Third, even within the formal and informal
sectors, women and men choose very different
jobs (figure 2.7). Women are more likely to be
in communal and public services, retail services,
and trade. Men are overrepresented in dangerous professions—such as mining, construction,
transport, and heavy manufacturing—with high
occupational injury rates in poor and rich countries alike. The burdens of defense and maintaining public order also fall heavily on men. These
patterns are similar across countries and regions,
and, if anything, they are accentuated at higher
incomes.

79

80

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

F I G U R E 2.7

Women and men work in different sectors (and
different occupations)
distribution of female / male employment across sectors

31 %

Communication Services

16 %

21 %

Retail, Hotels, and Restaurants

17%

13 %

Manufacturing

12 %

4%

Finance and Business

4%

0.5 %

Electricity, Gas and Steam, and Water

0.5 %
2%
27 %

Mining

2%

Transport and Telecommunications

7%

Agriculture, Hunting, etc.

29 %

Construction

11 %

All Sectors / All Occupations

100%

1%
100%

1%

Source: WDR 2012 team estimates based on data from LABORSTA Labor Statistics Database, International
Labour Organization.
Note: Totals do not necessarily add up due to rounding.

Such gender-differentiated patterns contribute to the persistence of sizable gender gaps
in earnings. Differences in average wages by
gender range from 20 percent in Mozambique
and Pakistan to more than 80 percent in Côte
d’Ivoire, Jordan, Latvia, and the Slovak Republic. The gaps are slowly diminishing, partly because of improvements in education among
women relative to men, differences in the concentration of women in some sectors and occupations, and shifts in work experience patterns and career interruptions linked to greater
control over fertility.26

“

Housework and care are still a
woman’s domain
One domain where gender differences appear to
be particularly persistent is the allocation of time
to housework and care. Over time and across
countries, irrespective of income, women bear
disproportionate responsibility for housework
and care, while men are mostly responsible for
market work. These differences, deeply rooted
in gender roles, reduce women’s leisure, welfare, and well-being. An immediate outcome of
these different domestic responsibilities is that
men and women have very different patterns
of time use and different amounts of leisure.
These patterns have implications for women’s
ability to invest in education (chapter 3), their
agency (chapter 4), and their ability to take up
economic opportunities (chapter 5), and to
participate more broadly in economic, political,
and social life (chapters 4 and 6).
In six countries—with widely different incomes, economic structures, and social norms—
the patterns are remarkably similar (figure 2.8).
Everywhere, women devote 1 to 3 hours more a
day to housework than men; 2 to 10 times the
amount of time a day to care (of children, elderly, and the sick), and 1 to 4 hours less a day to
market activities. These are averages for all men
and women, and the differences are accentuated
with family formation. As chapter 5 describes,
marriage significantly increases the time devoted to housework for women but not for men.
Children significantly increase the time spent on
care by both men and women but more so for
women.
Time use for women and men converge as
income and education increase, mainly because
women become more like men (increasing their
hours devoted to market work and decreasing the

Women need more free time, women are more tired than men. . . . They take care of the
house, of the children. While men, they are the entire day at work and don’t have to
take care of the house. And if the woman has a job also, then she gets even more tired.
Adult woman, Moldova

These days, for a woman to be rated as a ‘good wife’ one has to be a superwoman,
working very hard both at home and in the oﬃce, fulﬁlling every demand of your
family members as if we don’t have any right to enjoy.

”

Adult woman, Bhutan

The persistence of gender inequality

F I G U R E 2.8

Across the world, women spend more hours each day on housework
and care than men … and men spend more time in market activities
FOR SALE

Market activities

Housework

Child care

Pakistan
0.6

4.7

5.5

2.5

1.2

0.2

2.7

3.8

4.4

3.3

0.9

0.1

2.1

3.8

4.2

1.8

0.5

0.0

2.9

3.9

4.7

2.6

0.4

0.1

3.2

4.6

3.2

2.3

0.6

0.3

2.1

4.8

4.9

1.4

0.6

0.2

Cambodia

South Africa

Bulgaria

Sweden

Italy

women

= 12 hours

men
Source: Berniell and Sánchez-Páramo 2011.

hours to housework and care), not because men
take up more housework and care (chapter 5).

Less voice and less power
Some dimensions of gender equality where
progress has been slowest fall in the domain of
women’s agency. Consider three aspects. First,
women’s ability to make decisions about earned

income or family spending reflects their control over their own lives and their immediate
environment. Second, trends in domestic violence capture intrahousehold gender dynamics
and asymmetric power relations between men
and women. Third, patterns in political voice
can measure inclusiveness in decision making,
exercise of leadership, and access to power.

% of women not involved in decisions about their own income
women in richest quintile

⽧women in poorest quintile
all women, average

Source: WDR 2012 team estimates based on Demographic and Health Surveys.

Less control over resources
Many women have no say over household finances, even their own earnings. The Demographic and Health Surveys show that women

“

in some developing countries, particularly in
Sub-Saharan Africa and Asia, are not involved
in household decisions about spending their
personal earned income. As many as 34 percent
of married women in Malawi and 28 percent of
women in the Democratic Republic of Congo are
not involved in decisions about spending their
earnings. And 18 percent of married women in
India and 14 percent in Nepal are largely silent
on how their earned money is spent.27
Husbands have more control over their
wives’ earning at lower incomes. In Turkey, only
2 percent of married women in the richest fifth
of the population have no control over earned
cash income, a proportion that swells to 28 percent in the poorest fifth. In Malawi, 13 percent
of married women in the richest fifth have no
control, compared with 46 percent in the poorest fifth (figure 2.9).
Less control over resources and spending is
partly a reflection of large differences between
men and women in the assets they own. Assets
are typically inherited, acquired at marriage, or
accumulated over the lifetime through earnings
and saving. As shown above and explored further in chapter 5, women typically earn less than
men, particularly when aggregated over the life
cycle. This disparity directly affects their ability
to save, irrespective of male-female differences
in savings behavior. And as chapter 4 explores,
inheritance and property rights often apply differently to men and women so that gender disparities in access to physical capital and assets
remain large and significant. Land makes up the
largest share of household assets, particularly
for the poorest and rural households.28 Women
own as little as 11 percent of land in Brazil and
27 percent in Paraguay. And their holdings are
smaller than those of men. In Kenya, as little as 5
percent of registered landholders are women.29
In Ghana, the mean size of men’s landholdings
was three times that of women’s.30
In many countries, land ownership remains
restricted to men only, both by tradition and by
law. In most African countries and about half
of Asian countries, customary and statutory

Some working women don’t even know how much they get paid for their job because
their husbands cash their salary for them.

”

Adult man, West Bank and Gaza

83

The persistence of gender inequality

laws disadvantage women in land ownership.
According to customary law in some parts of
Africa, women cannot acquire land titles without a husbandâ&#x20AC;&#x2122;s authorization.31 Marriage is the
most common avenue for women to gain access to land. But husbands usually own it, while
wives only have claim to its use. While property
rights for women have slowly begun to improve
in some countries, legislation has often proved
insufficient to change observed practices.
More vulnerable to violence at home
Physical, sexual, and psychological violence
against women is endemic across the world.
A flagrant violation of basic human rights
and fundamental freedoms, violence can take
many forms. International statistics are not always comparable, yet incontrovertible evidence
shows that violence against women is a global
concern.32
Women are at far greater risk than men of
violence by an intimate partner or somebody
they know than from violence by other people.
According to South African data, for example,
teachers were the most common perpetrators
of the rape of girls under age 15 (one-third of
cases).33 About 50 percent of female homicides
in South Africa were perpetuated by an intimate
partner. The mortality rate from intimate partner violence there is estimated at 8.8 per 100,000
women.34 Overall, women are more likely than
men to be killed, seriously injured, or victims of
sexual violence from intimate partners.35
The number of countries with laws regulating intimate partner violence has risen. In 2006,
60 countries had specific legislation to address
domestic violence, up from 45 in 2003, and 89
had some form of legal provision. Many of these
are higher-income countries; most developing
countries with laws against intimate partner violence are in Southeast Asia and Latin America.
Yet in many nations, violence against women
is perceived as acceptable or justifiable. On average, 29 percent of women in countries with data
concurred that wife beating was justified for arguing with the husband, 25 percent for refusing
to have sex, and 21 percent for burning food. In
Guinea, 60 percent of women found it permissible to be beaten for refusing to have sex with
their spouses. In Ethiopia, 81 percent of women
say that it is justified for a husband to beat his
wife for at least one of the reasons listed in the
Demographic and Health Surveys; 61 percent
reported violence to be appropriate for burning

â&#x20AC;&#x153;

I think that women are now a problem: they
get money and they no longer listen to us.
So, if you want to continue being a man in the
house, you need to bring the discipline. You
must beat her up, and if any child intervenes,
you also beat them. Then they all fear and
respect you.

â&#x20AC;?

Adult man, Tanzania

food and 59 percent for arguing with their husbands (figure 2.10).
The prevalence of domestic violence varies
greatly across rich and poor countries. Physical

Men can also be victims. Domestic violence
against them is more circumscribed than against
women, in incidence, nature, and severity. According to the National Crime Victimization
Survey in the United States, intimate partner
violence affected 4.1 females per 1,000—more
than half a million women—and 0.9 males per
1,000—117,000 men—in 2009. So men were a
fifth as likely to be victims of domestic abuse
as women. In England and Wales, about two
in five domestic violence victims between 2004
and 2009 were men. Based on data from the
British Crime Survey, about 4.0 percent of men
(4.8 percent of women) reported suffering partner abuse in the past 12 months, an estimated
600,000 male victims.38

% of women having suffered
physical or sexual violence
lifetime
last 12 months

Source: World Health Organization 2005.

or sexual abuse by an intimate partner within
the last 12 months was most prevalent in Ethiopia (Butajira) and Peru (Cusco), involving 54
and 34 percent of women respectively. At the
other extreme, Japan (Yokohama) and Serbia
(Belgrade) are below the 4 percent mark (figure 2.11). In many instances, the violence can
be grave. In Peru (Cusco), almost 50 percent of
women are victims of severe physical violence
during their lifetime.36 And even with low incidence, the numbers are unacceptably high. A
3 percent domestic abuse incidence rate for Poland is equivalent to 534,000 women in one year,
or 1,463 new women a day.37
Domestic violence knows no boundaries,
but incidence rates tend to rise with socioeconomic deprivation. Reported across all economic groupings, it is usually most prevalent
among economically disadvantaged women.
Women’s low social and economic status can be
both a cause and a consequence of domestic violence. Low educational attainment, economic
duress, and substance abuse are among the many
compounding factors for abusive behavior.

Less likely to hold political office
Few nations have legal restrictions for women to
run for public office, yet the number of women
holding parliamentary seats is very low, and
progress in the last 15 years has been slow. In
1995, women accounted for about 10 percent
of members of the lower or single houses of national parliaments, and in 2009, 17 percent.39 In
Africa and most of Asia, the number of female
parliamentarians more than doubled. Also during the last 15 years, the number of countries
with at least 30 percent women as parliamentarians rose from 5 to 23—including 7 from
Sub-Saharan Africa as well as Argentina, Cuba,
Finland, Iceland, the Netherlands, and Sweden.
Rwanda’s parliament has 56 percent women, up
from 17 percent in 1995. East Asia registered the
least progress, and the number of women parliamentarians in particular is low in the Pacific
Islands.
Although men and women are equally likely
to exercise their political voice by voting, men
are often perceived to be superior in exercising
political power. Responses to the World Values
Surveys over several years point to a general
positive evolution of views on gender equality
in politics in the last decade (figure 2.12). But
people continue to view men as “better” political and economic leaders than women.
And men have better chances than women of
winning an election. The likelihood of a female
candidate winning a parliamentary seat over a
man is estimated to be 0.87 (with 1 signifying
that men and women are equally likely to succeed in an electoral contest), with considerable
variation across countries. Women have greater

The persistence of gender inequality

F I G U R E 2.12

Men are perceived as
better political leaders
than women

Georgia
India
Russian Federation
Turkey
Romania
Ukraine

percent in 1998. Higher female participation in
cabinet positions can be observed in every region, especially in Western Europe, Southern
Africa, and Latin America and the Caribbean.
In 1998, women occupied more than 20 percent
of ministerial posts in only 13 countries, but 63
countries 10 years later. In 2008, Chile, Finland,
France, Grenada, Norway, South Africa, Spain,
Sweden, and Switzerland had cabinets with
more than 40 percent female ministers.41

% of people who believe that
men make better political
leaders than women do
highest value is past’s value and the lowest is today’s value
highest value is today’s value and the lowest is past’s value

Source: WDR 2012 team estimates based on World Values Surveys,
waves 1994–97 and 2005–07.

chances of prevailing over men in Africa. In contrast, in Asia and high-income countries, women’s chances drop considerably. Women are least
likely to win elections in the Pacific Islands and
Latin America and the Caribbean.40
Quotas and reservations have helped expand
female parliamentary representation. Ninety
countries have some quota mechanism for parliamentary representation, whether in seat reservation, candidate quota legislation, or voluntary
political party quotas. Sixteen countries, all in
Africa and Asia, explicitly reserve parliamentary
seats for women. In others, such as Finland, there
has been little change. For instance, 38.5 percent
of newly elected members of parliament in Finland in 1991 were women, and by 2011, this
share had increased marginally to 42.5 percent.
Women’s participation in cabinets, regardless of the structure and size, has also lagged.
The proportion of women among ministers
was on average 17 percent in 2008, up from 8

The gender disadvantages discussed in this
chapter form the backbone for the analysis
in the remainder of the report—and the policies advanced to mitigate them. In contrast to
these facets of gender relations, where there is
often a clear pathway for analysis, the gendered
impact of external shocks, which can generate large losses in welfare and well-being, depends on many specific circumstances. In some
cases, men or boys are worse affected; in others,
women and girls. The impact of shocks can be
temporary, with large losses in welfare after the
shock followed by subsequent catch-up.42 But
some shocks, especially when they hit early in
life (as in the critical first three years) can also
have irreversible consequences. Outlined here is
the multifaceted nature of external shocks and
their impacts. The message: protection against
shocks should be a key part of any development
policy, and whether a gendered lens is appropriate depends on context.
Whether the source is financial, political, or
natural (box 2.1), shocks and hazards can affect
men and women differently, a function of their
distinct social roles and status. First, market failures, institutional constraints, and social norms
can amplify or mute gender differences in the
impact of shocks. The mechanisms that produce
these outcomes are multiple. For example, the
higher mortality rates for girls and women in
the 2004 Indian Ocean Tsunami have been related to their more limited mobility caused by
restrictive clothing and caring for small children.43 Second, those failures, constraints, and
norms can amplify or mute gender differences in
the vulnerability to shocks. The fact that women
tend to own and control fewer assets than men,
for example, can make them more vulnerable to
expected income shocks.

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B OX 2.1

The many faces of climate change

Climate change results in more frequent droughts and floods and more variable rainfall. A rising fraction of the world population is affected by climatic
shocks and natural disasters as a result of their greater frequencies and larger
numbers of people in disaster-prone areas. Cold days, cold nights, and frosts
have become less frequent, while the frequency and intensity of heat waves
have increased. Both floods and droughts are occurring more often. The interiors of continents have tended to dry out despite an overall increase in total
precipitation. Globally, precipitation has increased, with the water cycle sped
up by warmer temperatures, even as the Sahel and Mediterranean regions have
more frequent and more intense droughts. Heavy rainfall and floods have
become more common, and there is evidence that the intensity of storms and
tropical cyclones has increased.
Women appear more vulnerable in the face of natural disasters, with the
impacts strongly linked to poverty. A recent study of 141 countries found that
more women than men die from natural hazards. Where the socioeconomic
status of women is high, men and women die in roughly equal numbers during
and after natural hazards, whereas more women than men die (or die at a
younger age) where the socioeconomic status of women is low. Women and
children are more likely to die than men during disasters. The largest numbers
of fatalities during the Asian Tsunami were women and children under age 15.
By contrast, 54 percent of those who died in Nicaragua as a direct result from
Hurricane Mitch in 1998 were male.
Erratic weather can also affect agricultural productivity, which can reduce
the income and food of households. The reductions in food availability may not
affect all household members equally. And temperature and precipitation fluctuations may affect the prevalence of vector-borne, water-borne, and waterwashed diseases, as well as determine heat or cold stress.
Men and women may be affected differently by changing weather. Household evidence from rural India and Mexico suggests that this may be indeed
the case, but the impact and direction depend on the climatic shock and environmental context. In some locations in Mexico, rural girls can have lower
height-for-age than boys after a positive rainfall shock or a negative temperature shock. Yet girls in high-altitude areas have higher height-for-age than boys
as a result of warmer weather.

Two areas where shocks can generate significant reversals are in education and health outcomes and in access to economic opportunities.

Reversals in education and health
The health of infant girls tends to fare worse
as a result of negative income shocks. Undernutrition during gestation or infancy and declines in health-care-seeking behavior increase
mortality and morbidity risks in later life. In
India, the mortality of girls rises significantly as
a result of macroeconomic crises, but boys appear to be better protected.44 A study of 59 developing countries suggests similar results. The
average increase in infant mortality during an

economic contraction is 7.4 deaths per 1,000 for
girls, five times the 1.5 for boys.45 With proper
nourishment, older children and adults can usually compensate for nutritional deficits during a
shock.
In contrast, the impact of economic crises
on associated risky behavior, morbidity, and
mortality tends to be greater for men. The sudden political and economic transformation in
Eastern Europe fueled a sharp and unexpected
drop in male life expectancy. In many countries
in the region, particularly the Russian Federation, men bear a greater share of the burden of
ill health. Premature male mortality has been
overwhelmingly concentrated in the unmarried population. Women outlive men by nine
years on average—a gap larger than in the rest
of world. The rise in male mortality is partly
related to increased risky behavior, including
smoking and alcoholism.46 In Russia, a recent
survey shows that 19 percent of men, but only
1 percent of women, were classified as problem
drinkers.47 Stress owing to the absence of economic activities (challenging traditional gender
roles of men as breadwinners) and weak family
or social support networks are linked to the declines in male health.48
When families experience an income shock,
girls’ education suffers more than boys’ in some
countries but not in others. Girls in Turkey were
more likely than boys to drop out of school in
response to lower household budgets.49 And in
Indonesia, girls were more likely to be pulled out
in response to crop losses.50 Vulnerability to external shocks is particularly important because
interruptions in schooling can increase the risk
of dropping out, and lags and delays in school
progression can have a permanent impact on
overall grade attainment. In Ethiopia, girls ages
7−14 are 69 percentage points more likely to be
in school if they attended school in the previous period, and boys 21 percentage points more
likely.51
But boys may also be pulled out of school
during an economic shock, usually to bolster
household finances. When low-skilled work opportunities are available, boys more than girls
are very likely to be used to complement dwindling family income. While Ethiopian boys have
generally enjoyed greater access to schooling,
in times of economic crisis they have also been
the first to be withdrawn from school to work.52
And in Côte d’Ivoire, while enrollments of both

The persistence of gender inequality

boys and girls fell in response to drought, boys’
enrollments fell more (chapter 3).
Income shocks may have mixed effects in
relation to endowment accumulation. In some
instances (mainly in middle- and high-income
economies), income shocks can actually bring
boys and girls back into school. Wage reductions
or poor labor market conditions in a crisis lower
the opportunity cost of schooling, inducing
households to keep their children in school—especially boys who are more likely to be engaged
in wage labor. In Nicaragua, the school participation of rural boys increased 15 percentage points
after a sudden drop in coffee prices around
2000–02.53 In Argentina, the deterioration in
employment rates during the deep 1998–2002
financial crisis also increased the probability of
boys attending school.54

Reversals in access to economic
opportunities
Shocks can bring about reversals in economic
opportunities for both men and women.
Women tend to hold more precarious jobs, operate smaller and less capitalized firms, and be
engaged in more vulnerable economic activities
than men, suggesting that they would be more
likely to be affected by economic shocks. But the
evidence does not support this oft-held view.
In the recent financial crisis, there were no
common patterns by gender and no evidence
that women were more affected than men.55 Evidence from 41 middle-income countries suggests that the main impact was on the quality
of employment (number of hours worked and
wages), rather than on the number of jobs.56
Gender impacts vary significantly by country
and defy simple generalizations.57
Both labor market entry (added workers)
and exit (discouraged workers) during crises
might operate simultaneously, affecting different groups of women differently. Women from
low-income households typically enter the la-

“

The ﬁnancial situation in Moldova
is very bad. I think that women
should stay home and take care of
the family.

”

Adult man, Moldova

bor force, while younger, more educated women
from wealthier households often exit the labor
market in response to economic crises. The impact of crises on women’s labor force participation has often been the strongest in the informal
or unregulated sectors of the economy, which
more readily absorb additional women in petty
commerce or domestic service.58
The direction of labor market impacts and
their gender differences depend on the nature
of the macroeconomic shock. Export-oriented
industries, such as light manufacturing, were
the initial casualties in the most recent financial
crisis. Higher female participation rates in these
fields led to strong first-round negative employment effects for women. But lower female
participation rates in sectors that shrank in the
crisis, such as construction, or industries dependent on external demand, such as tourism, implied that the aggregate employment effects for
women relative to men were muted once these
second-round effects are taken into account.
In Latvia, Moldova, Montenegro, and Ukraine,
men tended to lose their jobs more than women.
The sectors most affected by the crisis in those
countries—such as construction and manufacturing—tend to be male-dominated.
Similarly, during the Asian crisis of 1997,
female employment was not the hardest hit.
Women in East Asian nations were disproportionately employed in firms more resilient to the
crisis.59 But the gender earnings gap increased,
particularly in larger firms. In other words,
women’s smaller net employment impact came
at the expense of a larger reduction in their
earnings.

“STICKY” GETS “STICKIER”
Chapter 1 noted that changes are interconnected. Progress in one dimension of gender
equality can multiply the effects on another
dimension. The same applies to an absence of
change. A lack of progress in one dimension
can compound the negative effects in another
dimension. Gender differences can thus endure,
bound together by many layers of constraints
that reinforce one other. Breaking this impasse
requires action on various strands of this web of
persistent inequality.
Maternal education is inversely correlated
with infant and child mortality in developing

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countries. In Mozambique, low maternal education is a strong predictor of low health service
use and child malnutrition.60 And stunted children—before 24 months of age—have poorer
psychomotor skills and lower cognitive achievement. Undernourished boys and girls are also
less likely to be enrolled in school or enter school
late, sustaining the cycle of deprivation.61
Poor health of girls and women spills over
into the next generation. Both contemporary
and childhood health of the mother matter
for the health of the next generation. Maternal
well-being—measured through short stature,
low body mass index, and anemia—affects
size at birth, survival, and child growth. So underinvesting in the health of girls and women
contributes to child mortality and intergenerational cycles of poor health among survivors.62
Girls who are born small and do not catch up
in growth fail to attain the height predicted by
their genetic potential. Their reduced uterine
and ovarian size implies lower birth weights for
their offspring, engendering a new intergenerational cycle of deprivation.63
Lack of property ownership and control matters for women’s agency. Assets are an important
element to boost voice and bargaining power
in household decision making, access to capital, and overall economic independence. Nepali
women who do not own land have less say in
household decision making than women with
land.64 In Colombia, a lack of property or social assets constrains women in negotiating for
the right to work, controlling their own income,
moving freely, and contesting domestic abuse.65
In Kerala, India, women’s independent ownership of immovable property is a significant predictor of long-term physical and psychological
domestic violence, over and above the effects
of other factors. The odds of being beaten if a
woman owns both a house and land are a twentieth of those when she owns neither.66
Cash employment is also strongly associated
with women’s empowerment. Not earning a
cash income is most consistently associated with
married women not making decisions—on topics such as their health care, large household
purchases, purchases for daily needs, and visits
to family or friends. Higher household wealth
by itself does not consistently enhance the likelihood that women will make decisions alone or
jointly in most countries.67

The clustering of men and women in different occupations and sectors begins earlier, in the
educational system. While female participation
is increasing across all fields of study as more
women enter tertiary education, segregation by
area of specialization remains. Male bias is most
marked in engineering, manufacturing, and
construction. In about two-thirds of the world’s
countries, men also outnumber women in science. But in nine-tenths of the world, women
outnumber men in education; humanities and
arts; social sciences, business, and law; and
health and welfare.
Educational segregation by specialization
does not go away—and even appears to increase—with economic development. Cambodia, Lao People’s Democratic Republic, Morocco, and Namibia are among the countries
with the least gender segregation by study areas,
though men are more likely to obtain a tertiary
degree. Among Organisation for Economic
Co-operation and Development (OECD) countries, Turkey has the least gender segregation in
tertiary fields of study, while Croatia, Finland,
Japan, and Lithuania have the most. In Norway
and Denmark, women make up two-thirds of
tertiary enrollments, but only a third of science
students is female.68
These are just several examples, among
many, of how constraints in one aspect of gender equality can hold back progress on other dimensions, causing gender inequality to persist.
This persistence comes with large economic,
social, and political costs. Part 2 of the Report
analyzes the foundations of these persistent gender disparities, rooting them in the interactions
between households, markets, and formal and
informal institutions.

hat gives women power? Conversations with
almost 2,000 women across 19 countries
show that they depend on a combination of
factors to feel empowered.1 “Increased confidence to manage the house independently,” “more communication with
neighbors and community members,” the ability to “go out
of house to do marketing, shopping, and other household
work such as paying electricity and water bills,” “increased
control of financial transactions in and outside the house,”
and “husband’s support and permission to go outside of the
house” were the main answers of women in Bhubaneswar, India, when asked to describe what it meant to be
powerful and free. Similarly, rural women from Paro,
Bhutan, associated gains in power with education,
spouse’s and family members’ support, and hard work—
but also with education programs for women who have
missed school and with role models such as elected female community leaders who “have helped women think
better” and female small business owners who have prospered and boosted the confidence of the women in their
community.
The characteristics of a powerful woman that come
up most often are related to generating and managing
income, followed closely by acquiring an education, and
then by personal traits and access to social networks
(spread figure 1.1).
It is also clear that no single factor can explain changes
in empowerment. Any one factor may be present for
many women with different levels of power and may
even determine gains or losses in power, depending on
other factors operating in women’s lives. For example,
changes in marital and family conditions create opportunities for some women when “the husband supports his
wife” (Papua New Guinea), or if they “get a good and understanding husband who can allow her to do business and
engage in educational activities” (Tanzania). And even a
divorce can be positive. “Divorce can free a woman from
a lot of strains and she’ll become stronger,” recognized
women in West Bank and Gaza. But for other women
the same process can have the opposite effect: “a woman
can fall [can lose power] if she loses her husband, her children, or the support of her parents” (Burkina Faso). “If you
have three children and your husband dies, a single income
would not be sufficient” (Peru). “[A] divorce when the man
leaves the wife it’s even worse than death for her” (Poland).
Women’s pathways to empowerment are determined
by different combinations of factors. To trace such pathways, women in each country were asked to place 100
representative women from their community on differ-

Source: WDR 2012 team calculations, based on “Deﬁning Gender in the 21st
Century: A Multi-Country Assessment” (dataset).

ent steps on a fictional “ladder of power and freedom”—
with the top step for women with the most power and the
bottom for those with the least. They were also asked to
repeat this ranking to reflect where the women would
have been on the ladder 10 years ago. In 79 percent of
cases, women saw a dramatic upward movement in the
past 10 years (almost 20 percentage points larger than
men’s perception of their gains in power in the same period). But that was not so in all cases. A community in
rural South Africa saw 80 percent of its women as being
at the bottom of the ladder, “All of us here are struggling,
so we have little power, and we are not free to do what we
want to do because we do not have money,” explained one
woman. They mentioned not having savings and having
difficulty purchasing basic goods, “What can they possibly
save, because whatever little money they have they spend on
food. It is very difficult to think about savings if you hardly
get money and you are always hungry because the little you
might get you want it to make your children happy at least
for that day,” said another woman. They also pointed to

Women’s pathways to empowerment: Do all roads lead to Rome?

the daunting number of people suffering from HIV/
AIDS. A powerless woman “is often sick, her health is unstable, and she cannot even access health facilities because
the clinic is very far and she does not have money for transport,” and “her husband is likely to be sick.”
In the Dominican Republic’s capital city, Santo Domingo, women reported fast upward movement on
their ladders thanks to two factors: “now women study
more and work more.” In Afghanistan’s Jabal Saraj, where
women placed 60 of the 100 women on the top step,
twice the number of 10 years before, a larger combination of conditions was identified: “In the past, women
did just home chores like cooking at home and warming
the oven, but now there are possibilities such as gas and
electricity.” “Now some women have jobs out of the house
and most of the girls are going to school.” And women have
“participated in election as candidates for provincial council and others.”
Each community had its own stories to explain
changes in women’s power, but many elements were the
same from community to community. To understand
the main commonalities and combinations of factors
driving female empowerment, a comparative qualitative
analysis combining dimensions of agency with the structure of opportunities in the community and the national
human development level was conducted.2 The variables
included:
• Dimensions of agency. Women’s control over assets,
control over family formation, freedom from domestic violence, freedom of physical mobility, and bridging social capital—from community networks to
family support and friends.
• Specific characteristics of the community environment
or structure of opportunities. Informal institutions
(level of pressure to conform to gender norms and
positive/negative vision of gender norms); formal institutions (presence of services in the community
such as transport, schools, health, electricity, and water); and economic opportunities for women and
markets (availability of jobs and share of women
working in the community).
• General national context for human development—
measured by the country’s score on the United Nations Development Programme’s Human Development Index (HDI).
Various combinations of these factors were tested
to distinguish the necessary conditions for women’s
empowerment in each case, the common explanations
across countries and cultures, and the factors that were
sufficient by themselves to explain gains in power and

freedom in relation to other constraints and barriers that
women were facing.
A higher national HDI or a low prevalence of domestic violence was sufficient to explain women’s empowerment gains in half the communities across all countries.
Either factor by itself counters negative conditions, such
as restricted mobility or lack of jobs.
For rural women, participation in social networks—
organizations and networks for women in the community, their relevance in the community, and the presence
of female leaders—was a key factor. Higher social capital
and network presence countered obstacles like domestic
violence in 25 percent of the communities. Social capital
is the only factor that allows women to feel empowered
even when facing high levels of domestic violence in their
communities. In its absence, women have to increase
their agency on many aspects—freedom of movement,
control over family formation, and control of assets—to
counter the disempowering force of domestic violence.
Restrictions in any of the other agency conditions are less
binding if domestic violence incidence is low.
Urban women depend as much on the local structure
of opportunities—availability of jobs for women and
a dynamic labor market—as they do on social capital.
In fact, when both come together, lack of control over
family formation or high incidence of domestic violence
becomes less of an obstacle. When social capital is not
strong, the relevance of the local structure of opportunities increases, but it needs to be paired with other
positive gains in agency such as increased control over
assets or freedom of movement and of violence threats
for women to move up their power ladder.
These different combinations show that pathways
may vary, but some combinations drive women’s gains
faster and better. The effect of any factor is likely to depend on the configuration of other factors—the role of
economic opportunities will depend on each woman’s
ability to move freely as well as on asset ownership and
social capital.
What do these pathways look like? Two examples
from two communities:
“A woman who is powerful is called omukazi [powerful
woman]. I think most of us here are powerful women,” says
Joyce in Bukoba, Tanzania, after acknowledging that the
lives of women in her community have prospered, “Yes,
women have always moved up. I was married, and I really
suffered with my husband. When I left him, it is when I
started doing my things and I am now very fine: I can get
what I want; I can do what I want; I take my children to
school” (spread figure 1.2).
For women in Bukoba, social capital has been the key
element. The community has a good array of organiza-

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S P R E A D F I G U R E 1 .2

Ladder shares now and
10 years ago in Bukoba,
Tanzania (urban)

SPREAD FIGURE 1.3

Ladder shares now
and 10 years ago in
Dhamar, Republic of
Yemen (rural)

100
100

90

90

80

80

70

percent

percent

70
60
50
40

60
50
40

30

30

20

20

10

10

0

0
women now
top step

women 10
years ago

men now

middle step

men 10
years ago
bottom step

women now
top step

women 10
years ago

men now

middle step

men 10
years ago
bottom step

Source: WDR 2012 team calculations, based on “Deﬁning Gender in the 21st
Century: A Multi-Country Assessment” (dataset).

Source: WDR 2012 team calculations, based on “Deﬁning Gender in the 21st
Century: A Multi-Country Assessment” (dataset).

tions helping women, and 33 percent of the local council
members are female. Women recognize the value of their
networks: “We have these self-help groups, we meet there
and talk about so many things that happen in our lives. You
get advice from your fellow woman on how to deal with
men who disturb you in your family or how to do business.”
“Once you get the right group and listen to what they say,
you get up.” Friends also have a central role: “These are the
people you count on as woman. They will give you advice.
They form part of the groups you belong to. And when you
have quarrels with your husband, they will be the first ones
to come and assist. If you have small children, they will always keep an eye on your children.”
But social capital is not enough to increase women’s
empowerment. It needs to be combined with a good
structure of opportunities and services, which women in
Bukoba also seem to have: “You can go to the factory and
ask for different kinds of jobs, such as sweeping, cleaning
dishes or the compound, and even becoming their agent to
buy and bring fish to the factory.” Favorable laws are also
in place: “It is easy because the law is clear. No one loses as
such: you want to divorce, you divide the property, and each
one goes his or her way.”
Women in Bukoba also recognize the barriers that
prevent other women in the community from gaining
power and freedom: “The moment you know that you can
do things by yourself and not depend on a man is the moment you begin going up. I see some women being beaten

by their husband every day and they are there. When you
talk to them, they say they are married and they cannot
separate. These women will never climb the ladder; they
will stay at the bottom.”
In rural Dhamar in the Republic of Yemen, women
also see themselves moving up despite low economic
participation and education in their community (spread
figure 1.3). Like the Bukoba women, their pathway includes social capital—in this case in the shape of informal
networks—as well as some gains in education, all in an
environment with too few opportunities and some mobility restrictions. “Men can finish their education; men
have the freedom to go out and to learn [but] women visit
each other in their free time and chat,” said Fatima and
Ghalya when comparing their happiness with men’s. In
their community, a powerful woman would have many
acquaintances and friends, while a woman with little
power “is the woman who doesn’t have influence among
Dhamar’s women.”
Women in Dhamar see two factors as the most pressing: having an education, and being able to move more
freely. Having freedom means having the ability to move
within the village. But most women cannot travel outside the village without appropriate companionship:
“A woman cannot work outside the village unless she has
Mahram (male legal guardian) with her.” Gaining mobility will allow them to finish their education and those
who dropped out of school to resume it. “If there is

Women’s pathways to empowerment: Do all roads lead Overview
to Rome?

transportation, they will let me learn, and I can become a
teacher,” says a young woman. Job aspirations are linked
to mobility restrictions: “Work opportunities are limited
inside the village except teaching, and recruitment for men
in agricultural work.” Although these Yemeni women
experience many difficulties, they nonetheless see improvements in their power and freedom over the previous generations.

NOTES
1. The study economies include Afghanistan, Bhutan, Burkina
Faso, the Dominican Republic, Fiji, India, Indonesia, Liberia, Moldova, North Sudan, Peru, Papua New Guinea, Poland, Serbia, South Africa, Tanzania, Vietnam, West Bank
and Gaza, and the Republic of Yemen. The focus groups included male adults, female adults, male youth, female youth,
male adolescents, and female adolescents; the adolescent
groups were conducted only in a subset of 8 of the 19 coun-

tries. For further information, the assessment methodology
can be found at http://www.worldbank.org/wdr2012.
2. Fuzzy-set qualitative comparative analysis (fs/QCA). For
references, see Ragin (2008) and Ragin (2000). The technique allows for testing models of different pathways to
achieve an end, in this case, the levels of empowerment
reported by the women in the various community groups.
Given the nature of qualitative data—textual and representative of individuals’ voices, perceptions, and experiences—comparing across countries and communities is
done by measuring different degrees in the cases that fit
each model (membership degrees).

art 2 of this World Development Report explains why
progress toward gender equality has been made in
some areas but not in others. For this purpose, we use
a conceptual framework positing that households, markets,
and institutions (both formal and informal) and the interactions among them shape the relationship between economic
development and gender equality and that, in doing so, they
ultimately determine gender outcomes (see overview box 4).
This framework builds on earlier work within the World Bank
and elsewhere.
We apply this framework to analyze the evolution of gender
differences in endowments (chapter 3), agency (chapter 4), and
access to economic opportunities (chapter 5) as well as the impact of globalization on gender equality, with a focus on access
to economic opportunities (chapter 6).
This empirical approach helps establish the link between
analysis and policy choices. It emphasizes that the design of
policies to reduce specific gender gaps needs to take into account
what happens in the household, in the functioning and structure
of markets, and in formal and informal institutions as well as in
the interactions between all of them. When these aspects are not
considered, the intended results of policy interventions can be
muted or even contrary to expectations.

EXPLAINING THE FRAMEWORK
The proposed framework builds on three premises. First, the
household is not a unitary block with a common set of preferences and goals. Instead, it is made up of different members
with their own preferences, needs, and objectives, as well as different abilities to influence decision making in the household.
Second, markets and institutions affect the relationship between
economic development and gender equality both directly and
indirectly (through their impact on household decisions). Third,
markets and institutions are not static but are shaped and conditioned by society (understood as the sum of individuals and
households). And it is precisely this process that allows markets
and institutions, including social norms and values, to evolve
over time in response to policy interventions or exogenous
changes brought about by, say, globalization.
Building on these three ideas, the framework captures how
households make decisions, how they interact with markets and

institutions to determine gender outcomes, and how policy
can affect these interactions and ultimately gender outcomes.

Understanding how households make decisions
Households make decisions about how many children to have
and when to have them, how much to spend on education
and health for daughters and sons, how to allocate different
tasks (inside and outside the household), and other matters
that determine gender outcomes. These choices are made on
the basis of the preferences, decision-making (or bargaining)
power, and incentives and constraints of different household
members.
Preferences can be innate or shaped by gender roles, social norms, and social networks (grouped under the label
informal institutions). And they may be shared by or differ across individuals within the household. For instance,
evaluations of transfer programs, such as pensions and conditional cash transfers, show that spending decisions differ
depending on whether money is given to women or men
within the household, suggesting differences in men’s and
women’s preferences.1
Bargaining capacity is determined by two distinct sources
of individual power: economic and social. Economic bargaining power depends primarily on the wealth and assets each
individual controls and his or her contribution to total household income, while social bargaining power results primarily
from formal and informal institutions. For instance, a woman’s capacity to decide how to allocate her time across various
activities in and outside the household may be weakened by
her lack of asset ownership (low economic bargaining power)
or by strong social proscriptions against female work outside
the home (low social bargaining power).
In addition, economic and social bargaining power is influenced by an individual’s capacity to take advantage of opportunities outside the household and to bear the costs of
leaving the household (“exit”). For example, where custody of
children in the case of divorce is based primarily on financial
capacity to care for the children, women’s capacity (and willingness) to use the threat of exit as a bargaining tool may be
limited by their own incomes and assets.
Finally, incentives and constraints are largely influenced
by markets and institutions. Markets determine the returns
to household decisions and investments and thus provide
99

100

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

incentives for the allocation of limited resources to competing ends. For instance, the returns to education in the labor
market—both in better employment opportunities and higher
wages—will influence decisions to send a girl or boy to school.
Similarly, the level of female wages will influence whether
women will devote more time to market work, at the expense of
housework and care.
Constraints arise from markets, institutions, and their interplay. Discrimination against women in the labor market, for example, limits the number and types of jobs that women can take
on. And traditional norms for women’s role in the economic
sphere may reinforce the discrimination. Similarly, the availability of an adequate school can affect the decision to send girls
(and boys) to school.

Understanding the relationship between economic
development and gender equality
The relationship between gender equality and economic development (the combination of higher incomes and better
service delivery) is a two-way relationship. In the framework
here, households, markets, and institutions and their interactions shape this relationship and ultimately determine gender
outcomes.
Start with the impact of economic development on gender
equality. Higher incomes and better service delivery can increase
gender equality, acting through markets and institutions in ways
that affect household decisions. Education and health provide a
good illustration.
• First, to the extent that aggregate economic growth translates
into higher household incomes, constraints on access to education and some health services are relaxed. So, fewer households will have to choose between girls and boys and women
and men in providing or accessing these services.
• Second, the changes in market structures and signals that
typically accompany growth (such as the expansion of manufacturing and service activities) and encourage the greater
participation of women in the wage labor market also work
to reduce these gaps by placing a greater value on girls’ education and by empowering women in household decision
making.
• Third, economic development means the improved delivery
of public services such as health and education. And these institutional improvements lower their costs to households, allowing them to use more of them—for males and females—
with attendant improvements in gender outcomes.
The combination of higher incomes, higher returns to human capital investments, and better access to services strengthens the incentives for and lowers the constraints to investing in
girls and women’s human capital and is then likely to lead to
a reduction in gender gaps in educational attainment and in
health outcomes such as life expectancy.

But markets and institutions can also dampen the impacts
of growth for many gender outcomes, which means that some
gender biases do not disappear with economic development—
the “sticky domains” discussed in Part 1. Persistent differences
in the jobs that men and women perform provide a good example. These differences are rooted in the ways markets and
institutions work and channel men and women into different
segments of the economic space. These mutually reinforcing
market and institutional barriers, including those related to
gender roles and norms, mute the impact of economic development on the incentives and constraints for women’s access
to economic opportunities.
What about the impact of gender equality on economic development? As argued in this Report, greater gender equality
enhances economic efficiency and improves other development outcomes through three main channels: productivity
gains associated with better use of existing resources, improvements in outcomes for the next generation, and more
representative institutions and policy making. When aligned,
households, markets, and institutions can support and
strengthen these positive links. For example, well-functioning
and affordable education and health systems can ease restrictions on access to human capital among women—especially
where distance and mobility are factors and where the private
sector can step in to fill gaps in public sector provision. Similarly, if labor markets work well, educated women will enter
the labor force and contribute their talents and skills.
But in some cases, market and institutional constraints can
lead to inefficient gender outcomes both in the household and
outside it, impeding economic development. For instance, insecure land property rights among female farmers in Africa
lead to lower than optimal use of fertilizer and other productive inputs and shorter than optimal fallowing times, reducing
agricultural productivity. And when employment segregation
excludes women from management positions, the average talent of managers is lower, reducing technology adoption and
innovation.
We refer to these situations as market failures and institutional constraints. Market failures occur with discrimination,
information problems, or limitations in the type and nature
of contracts available.2 Institutional constraints, by contrast,
arise from legal restrictions, customary practices, social norms,
or other formal or informal institutional arrangements that
result in failures to determine and enforce rights. Correcting
these market failures and institutional constraints can yield
substantial productivity gains and broader economic benefits.
And in a more competitive and integrated world, even modest
improvements in how efficiently resources are used can have
significant effects on a country’s competitiveness and growth.
These ideas are illustrated in our framework graph by the
interconnected gears representing markets, formal and informal institutions, and households (figure P2.1). Propelled by
economic growth, the gears representing markets and insti-

101

What has driven progress? What impedes it?

Gender outcomes result from interactions between households, markets, and institutions

F I G U R E P 2.1

po

ND E
GE

lic

R EQUALIT

Y

ies
MAL
INFOR

S

UTION

INSTIT

ECONOMIC
OPPORTUNITIES

TS
RKE
MA

HOUSEHOLDS

AGENCY

FOR

MAL

GR

OW

ENDOWMENTS

INST
ITUT
ION
S

TH

Source: WDR 2012 team.

tutions turn, moving the household gear. The combined movement of these gears ultimately triggers the turning of the gear
representing gender outcomes, thus increasing gender equality.
One can also imagine the movement going in the opposite directionâ&#x20AC;&#x201D;that is, with the gender equality gear moving those representing households, markets, and institutions and ultimately
generating higher economic growth. In this setting, market and
institutional constraints can be thought of as wedges that prevent
one or more gears from turning, thereby weakening both directions of the two-way relationship between economic growth and
gender equality. Throughout the Report we use the color green
to indicate when markets, formal, and informal institutions are
functioning to strengthen the relationships between economic
development and gender equality, and the color red to indicate
when they are acting as constraints on these links.
Although we have described the framework as a snapshot at
one point in time, we also use it to look at changes over time.
Allocation decisions and agency formation in the household
take place in a dynamic context, with outcomes today affecting
both decision making and returns in the future. For example, as
individuals work and earn income, they can accumulate assets,
affecting their bargaining power and thus future household allocation decisions. In addition, greater access to assets may mean
that the household or some individuals in the household can

also command higher returns, increase their productivity, or
bothâ&#x20AC;&#x201D;and ultimately earn a higher income.
An individual or a household has little capacity to change
the way markets and social institutions function, but society does (as the sum of individuals and households). And it
is precisely this capacity that allows markets and institutions
to evolve over time as a result of collective action, policy interventions, or outside changes brought about by, say, exposure to norms, values, and practices in other societies through
global integration.

APPLYING THE FRAMEWORK
The four chapters in Part 2 use this framework to address two
questions. What explains progress or the lack of progress in
closing gender gaps in endowments, agency, and access to
economic opportunities? And how has globalization affected
gender equality? The answers to these questions point to the
role for policies and their likely impacts.
Applying this framework produces important insights.
Progress has come fastest in areas where market and institutional forces have aligned to provide strong incentives
for households and societies to invest equally in men and

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WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

women—reversing any previous disadvantages that girls and
women may have faced. In these cases, progress has been propelled by forces acting through various points of entry—
markets, formal institutions, and informal institutions. This process has been aided where economic growth has been sustained
and broad-based, as in education, where gender gaps have closed
very rapidly (chapter 3).
In contrast, progress has stalled—even with economic
growth—where market and institutional constraints reinforce
inequalities between women and men in endowments, agency,
and access to economic opportunities. This situation can arise
when constraints in one of the three spheres through which economic development affects households—markets, formal institutions, and informal institutions—are particularly binding, or
when constraints in all three spheres are mutually reinforcing.
In the first case, there is a single entry point for policy action
in that the most binding constraint has to be removed for improvements in gender outcomes to occur, as illustrated by the
discussion of excess female mortality in chapter 3. In the second
case, improvements in gender equality will require coordinated
interventions in a number of spheres, as illustrated by the discussion of women’s agency and access to economic opportunities in chapters 4 and 5.
Against this background, globalization has operated through
markets and institutions to lift some of the constraints to gender equality in human capital, agency, and access to economic
opportunities. But the women most affected by existing constraints risk being left behind in the absence of public action
(chapter 6).
Based on the analysis in chapters 3–6, four priority areas for
public action are identified: reducing gender gaps in human
capital, promoting women’s access to economic opportunities,
closing gender gaps in voice and agency, and limiting the inter-

generational reproduction of gender inequality. In these areas,
progress has been slow and often unresponsive to economic
development alone.
So, in these areas, the role of policy is twofold. It can
strengthen the relationship between gender equality and economic growth, and it can address the market failures and institutional constraints that stall progress. The first idea is illustrated by the drops of oil that ease the turning of the market
and institutions gears. The second is equivalent to removing
wedges that stop some gears from moving. A more detailed
discussion of the rationale for and role of public action is in
Part 3.

NOTES
1. Duflo 2003; Lundberg, Pollak, and Wales 1997.
2. Information problems include information asymmetries and externalities. With information asymmetries, market participants
are unable to gather or have differential access to necessary information. Externalities imply that the behavior of some market participants affects the outcomes of others in the same—or
other—market.

nvestments in health and education—
human capital endowments—shape the
ability of men and women to reach their
full potential in society. The right mix of
such investments allows people to live longer,
healthier, and more productive lives. Systematic differences in investments between males
and females, independent of their underlying
causes, adversely affect individual outcomes in
childhood and adulthood and those of the next
generation. Left uncorrected, these differences
translate into large costs for societies.
Where do gender differences arise in human
capital endowments, how are they reduced,
and when do they persist? Global comparisons
of participation in education and mortality risks
among women and men show that progress has
been tremendous where lifting a single barrier is sufficient—for households, markets, or
institutions.
Consider the increasing participation of
women at all educational levels. Gaps in primary
enrollments have closed, and in secondary and
tertiary enrollments, new gaps are emerging—
for boys. College enrollments increased sevenfold
for women over the past three decades, fourfold
for men. The reason is that interventions targeted at any one of households or markets or institutions have all increased enrollments. Where
all three drivers have come together, change has
accelerated. Conversely, where all three have not
changed, progress has stalled. Further reducing
girls’ disadvantages in educational participation
requires sharpening the focus on severely disadvantaged populations, for whom all the drivers of
progress are missing.

Overall, progress has been slower where
multiple barriers among households, markets,
and institutions need to be lifted at once or
where there is only a single effective point of entry for progress. Consider each in turn.
Although girls participate equally (or more)
at all education levels, the educational streams
they choose are remarkably different and stable
across countries at very different incomes. Men
continue to study engineering while women
continue to learn how to be teachers. While part
of the problem lies in the educational system,
these patterns are reinforced by gender norms
in households and markets. Some gender norms
relate to care in the household (overwhelmingly
provided by women) and its implications for
the kinds of jobs that women choose. Others
have to do with the continuing “stickiness” in
employers’ attitudes toward family formation
and childbearing. Equal gender participation in
different fields of studies requires simultaneous
changes among households, markets, and institutions. That has not happened so far.
Things can also get stuck where there is only
one point of entry: households or markets or
institutions.
Health disadvantages for women fall in this
category. Consider girls missing at birth (a deficit of female births relative to male ones) and
excess female mortality after birth (women and
girls who would not have died in the previous
year had they been living in a high-income
country after accounting for the overall mortality of the country they live in).
Globally, girls missing at birth and deaths
from excess female mortality after birth add up

Education and health: Where do gender differences really matter?

to 6 million women a year, 3.9 million below the
age of 60. Of the 6 million, one-fifth is never
born, one-tenth dies in early childhood, onefifth in the reproductive years, and two-fifths at
older ages. Because those who died in the earlier
ages also had the longest to live, they account for
the bulk of lost women years around the world.
The problem is not getting any better. In 1990,
missing girls and excess female mortality below
the age of 60 accounted for 4 million women a
year; in 2008, the number was 3.9 million, fueled
by a near doubling in Sub-Saharan Africa. Unlike
Asia, where population-adjusted excess female
mortality fell in every country (dramatically in
Bangladesh, Indonesia, and Vietnam), most SubSaharan African countries saw little change in the
new millennium. And in the countries hardest
hit by the HIV/AIDS epidemic, things got worse.
In South Africa, excess female deaths increased
from (virtually) zero between the ages of 10 and
50 in 1990 to 74,000 every year by 2008.
Comparisons with Europe, where excess female mortality existed during the early 20th
century but disappeared by 1950, suggest that
the patterns today reflect a combination of overt
discrimination before birth, and poor institutions combined with the burden of HIV/AIDS
after birth. More than 1.3 million girls are not
born in China and India every year because of
overt discrimination and the spread of ultrasound technologies that allow households to
determine the sex of the fetus before birth. Informal institutions that generate a preference
for sons are the primary bottleneck.
After birth, overt discrimination plays a
smaller role. Instead, poor institutions of public
health and service delivery exact a heavy burden
on girls and women. In parts of Sub-Saharan
Africa, HIV/AIDS risks have compounded the
problem. But where countries have improved
basic institutions of public health and service
delivery, excess female mortality has declined.
Even in countries where historical studies identified discrimination against girls (like Bangladesh), better public health measures improved
life-chances for both boys and girls, but more so
for girls.1
Clearly, excess female mortality is not a problem in all countries. In the Russian Federation
and some other post-transition countries, mortality risks have increased for both sexes—but
particularly for men. In these contexts, there is
excess male mortality relative to high-income
countries today. Unlike mortality risks among

In-laws decide how many children to have. If the
first child is a girl, then they will ask to have more
children until a son is born.

”

Young woman, urban India

women, which arise from poor institutions,
excess male mortality is often tied to behavior
deemed more socially acceptable among men,
such as smoking, heavy drinking, and engaging
in risky activities.
Understanding both sorts of mortality risks
and what can be done about them is critical
for any notion of human justice. Solving excess
female mortality requires institutional changes;
solving missing girls at birth and excess male
mortality delves fundamentally into social norms
and household behavior—both of which are
more difficult to understand and tackle.

ENDOWMENTS MATTER
Education and health investments have a huge
impact on the ability of individuals—whether
men or women—to function and reach their
potential in society. For both boys and girls,
childhood investments in health affect outcomes
throughout the course of life. Low birth weights
and childhood exposure to disease have been
linked to lower cognitive development, schooling attainment, and learning in adolescence.
Less healthy children are at an elevated risk of
becoming less healthy adults.2 Poorer health
outcomes in adulthood in turn affect economic
outcomes, reflected in health-related absences
from the labor force and lower work hours and
earnings.3

“

Educated women do not sit around
and wait for men to provide for them.
They do not need a man to buy things
for them.

”

Young woman, urban South Africa

105

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WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

Similarly, as chapter 5 shows, investments in
education determine women’s ability to earn
higher wages and to own and operate productive farms and firms. On average, differences in
education explain a significant fraction of the
variation in wages and incomes among adults.
In both high- and low-income countries, gender differences in education have contributed
significantly to the productivity and wage gap
between men and women.
Health and education investments in women
are also special in three ways. First, in their roles
as mothers, educated women pass on the benefits of higher education to their children. Children born to more educated mothers are less
likely to die in infancy and more likely to have
higher birth weights and be immunized.4 Evidence from the United States suggests that some
of the pathways linking maternal education to
child health include lower parity, higher use of
prenatal care, and lower smoking rates.5 In Taiwan, China, the increase in schooling associated
with the education reform of 1968 saved almost
1 infant life for every 1,000 live births, reducing
infant mortality by about 11 percent.6 In Pakistan, even a single year of maternal education
leads to children studying an additional hour at
home and to higher test scores.7
Second, women face particular risks during
pregnancy and childbirth: 1 of every 11 women
in Afghanistan and 1 of every 29 in Angola
dies during childbirth.8 Compare that with 1 of
every 11,400 in Sweden. As this chapter shows,
maternal mortality and excess female mortality
in the reproductive ages are closely linked. But
high maternal mortality rates also have implications for educational investments and the ability
of women to participate in society. As the risk
of dying in childbirth declines, educational investments increase (and more so for girls).9 In
Sri Lanka, reductions in the maternal mortality
ratio increased female literacy by 1 percentage
point.10 And because reductions in maternal
mortality ratios also reduce maternal morbidity (in the United States in 1920, one of every
six women suffered from a long-term disability
stemming from giving birth), improvements in
the conditions of childbirth can drive increases
in the labor force participation rate of married
women.11
Third, overt discrimination that leads to
male-biased sex ratios at birth can have long-

run implications for society. If more boys than
girls are born, eventually many men will be unable to find wives. Recent research suggests that
such a “marriage squeeze” is already well under
way in China and India.12
These basic themes—educating girls and
women, improving health outcomes in childhood, lowering the risks of giving birth, and addressing skewed sex ratios at birth (the latter two
leading to excess female mortality and missing
girls at birth)—play out consistently in the rest
of the chapter. The focus throughout is twofold:
first, separating the problems that will likely
diminish with income growth from those that
will remain “sticky,” and, second, understanding
how and where policy can be effective through
the framework of this Report—the interactions
between households, markets, and institutions.

EDUCATION
A decade into the new millennium, there are
many reasons to feel optimistic about the state
of women’s education around the world. Progress has been remarkable, and many of the gaps
salient in the 20th century have closed. Today,
girls and boys around the world participate
equally in primary and secondary education. In
tertiary education, a clear bias is emerging that
favors women—with enrollments increasing
faster for women than for men.
These gains have been possible because, for
enrollments, lifting single barriers, whether stemming from households, markets, or institutions,
has been sufficient. These multiple entry points
have allowed policies to circumvent bottlenecks
arising from adverse preferences, low returns to
female education, or poor institutions.
But the optimism has to be tempered on
three fronts. First, in some countries and in

“

It is good to go to school because as a
woman if you are an educated person,
then men won’t take advantage of
you. So it is important that you go to
school.

”

Young woman, urban Liberia

107

Education and health: Where do gender differences really matter?

some populations within countries girls are
still the last to enroll and the first to drop out
in difficult times. These severely disadvantaged
populations face a host of different problems,
and the “best” solution to their problems will be
context specific. Second, children in low-income
countries learn far less than their high-income
counterparts. Low learning affects both boys
and girls, and gender differences are small. In a
globalizing world, poor skills will dramatically
affect the future outcomes of all children.
Third, women and men continue to choose
very different fields of study in secondary and
tertiary education. These patterns of stream divergence are similar across poor and rich countries, suggesting that increases in enrollments
and learning are necessary, but not sufficient,
to even the playing field in later life. The fields
of study that men and women choose feed into
their occupational choices, which in turn affect
the wages they earn throughout their adult lives.
There has been less success in addressing stream
divergence because many barriers need to be
lifted at the same time—households, markets,
and institutions need to change simultaneously,
through complex polices that act on multiple
fronts.

Most countries around the world have attained gender parity in primary education,
with an equal number of boys and girls in
school. Among children currently not attending primary school, 53 percent are girls, with a
concentration of gender disadvantage in some
African countries, including Benin, Chad, Niger,
and Togo. But, even in these countries, progress
has been substantial: in Sub-Saharan Africa the
number of girls for every 100 boys in primary
school increased from 85 in 1999 to 91 in 2008.
Moving from primary to tertiary enrollment
shows three patterns (figure 3.1). First, most
children participate in primary schooling, but
secondary enrollments range from very low to
very high across countries; again, some countries in Sub-Saharan Africa stand out for their
particularly low rates of participation. In tertiary education, low participation is the norm
in developing countries. Therefore, increases in
secondary (and tertiary) enrollment for both
boys and girls are necessary in several countries.
Second, at low overall levels of secondary enrollment, girls are less likely to be in school, while
at high levels the pattern reverses with the bias

Gender parity in enrollments at lower levels has been achieved in much of the world, but tertiary
enrollments are very low and favor women
Primary education
100

Some African
countries lag behind

school enrollment, girls, net, %

school enrollment, girls, net, %

100

80

60

40

20

girls
disadvantaged

0
0

20

40

60

80

South Asia

80

60

40

20

girls
disadvantaged

0

100

0

20

40

60

80

school enrollment, boys, net %

Europe and Central Asia

Sub-Saharan Africa

100

Enrollment gaps dwarf
gender gaps

school enrollment, boys, net %
East Asia and Pacific

Tertiary education

Secondary education

Latin America and the Caribbean

100

school enrollment, women, gross, %

F I G U R E 3.1

The good news

men
disadvantaged

80

60

40

Women are
more likely
to participate
than men

20

0
0

20

40

60

80

school enrollment, men, gross %
Middle East and North Africa

High-income countries

Source: WDR 2012 team estimates based on World Development Indicators.
Note: The 45° line in each ﬁgure above shows gender parity in enrollments. Any point above the 45° line implies that more women are enrolled relative to men.

100

108

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

now against boys. The number of countries with
girls disadvantaged in secondary education is
similar to the number with boys disadvantaged.
Third, in tertiary education, girls are more likely
to participate than boys—a difference that increases with overall participation rates. Between
1970 and 2008, the number of female tertiary
students increased more than sevenfold (from
10.8 million to 80.9 million), compared with a
fourfold increase among males.
While these results are positive, they illustrate disparities by gender only. An alternative
question is whether there are other dimensions
of disadvantage, and if so, what is the relative
weight of gender versus (say) poverty in the
production of inequality in schooling participation? Decomposing overall inequality in the
educational system into four components—
location, parental education, wealth, and gender—helps answer this question.13
Suppose that in two countries there is an equal
number of rich and poor households with boys
and girls in every income group. In Country A,

F I G U R E 3.2

all the rich, but only 50 percent of the poor, are
enrolled, and enrollment is no different for boys
and girls. In Country B, all rich and poor boys,
but only 50 percent of rich and poor girls, are in
school. Both countries have equal total inequality in the educational system, but the patterns
are very different. Decomposing total inequality
in these countries would show that inequality is
generated entirely by wealth (with all differences
across wealth groups) in Country A but entirely
by gender in Country B.
Repeating this exercise across many countries represented in the Demographic and
Health Surveys shows that in most of them, the
situation is similar to Country A—with differences in wealth accounting for most educational
inequality—not to Country B (figure 3.2). Poverty rather than gender feeds overall educational
inequalities in most of the world. In fact, even
in countries with high total inequality (countries where the differences in school enrollment
between advantaged and disadvantaged groups
are high), gender accounts for at most 38 per-

In most countries with moderate or high total inequality in educational outcomes, less than
one-fifth of inequality stems from gender
Inequality in school attendance among children 12–15 years old

contribution to total inequality, %

Low inequality

Moderate inequality

High inequality

100
80

60
40

20

gender

wealth

Turkey (2003)

Côte d’Ivoire (2005)

Chad (2004)

Benin (2006)

Niger (2006)

Mali (2006)

India (2005–06)

Guinea (2005)

Senegal (2008–09)

Sierra Leone (2009)

Ethiopia (2005)

Morocco (2003–04)

Burkina Faso (2003)

Liberia (2009)

Nigeria (2008)

Madagascar (2008–09)

Nepal (2006)

Lesotho (2009–10)

Cambodia (2005)

Congo, Dem. Rep. (2007)

Cameroon (2004)

Egypt, Arab Rep. (2008)

Mozambique (2003)

Bolivia (2008)

Colombia (2005)

Ghana (2008)

Peru (2004–08)

Malawi (2004)

Zimbabwe (2005–06)

Haiti (2005–06)

Vietnam (2002)

Tanzania (2007–08)

Azerbaijan (2006)

Zambia (2007)

Moldova (2005)

Maldives (2009)

Armenia (2005)

Namibia (2006–07)

Jordan (2009)

Ukraine (2007)

Guyana (2005)

Albania (2008–09)

Swaziland (2006–07)

Dominican Republic (2007)

Congo, Rep. (Brazzaville) (2009)

Kenya (2008–09)

Uganda (2009–10)

0

other factors

Source: WDR 2012 team estimates based on Demographic Health Surveys in various countries during 2002–10.
Note: The measure of inequality refers to the percentage of total opportunities that must be reallocated to ensure that all possible combinations of circumstances have the same
average enrollment. Low inequality is between 0.3 percent and 2.1 percent, moderate inequality is between 2.3 percent and 6.4 percent, and high inequality is between 6.5 percent and 26.7 percent. Results are sorted by size of gender contribution to total inequality.

109

Education and health: Where do gender differences really matter?

cent of overall inequality; in contrast, poverty
frequently accounts for 50 percent or more of
the total. Almost all countries where gender inequality is a problem, and where total inequality
is high, are in Africa—with India and Turkey the
only exceptions.
This basic description of progress on education shows that change has come to every country and region, and that in most countries, the
remaining inequalities are concentrated around
poverty and other circumstances (notably, rural
or urban residence) rather than gender. A global
focus on inequality would thus imply that, in
most contexts, redistributive efforts should now
be directed to poverty.
What explains the progress?
One key message of this Report is that progress
has come in areas where lifting a single barrier is sufficient. Consistent with this message,
studies now show that increasing the returns to
educational investment in girls or removing in-

F I G U R E 3.3

po

stitutional constraints or increasing household
incomes is sufficient to increase female participation in education (figure 3.3). When all three
have happened simultaneously, change has been
even faster. Take each in turn.
Changing returns. Starting from the early 1980s,
empirical evidence emerged that when returns
to women’s education increased, so did parental
investments in the schooling of girls. These early
studies showed that changes in the agriculture
technology that increased the returns to female
education also led parents to invest more in girls’
schooling. A new generation of work brings together globalization and returns to education in
the context of changing technologies.
The rise of outsourcing in India is offering new work opportunities—particularly for
women. The opening of a new informationtechnology-enabled service (ITES) center, for
example, increased the number of children
enrolled in a primary school by 5.7 percent,

with the increase driven primarily by higher
enrollments in English-language schools.14 This
increased enrollment was equally large for boys
and girls, reflecting very local information markets on the returns to education.
Similarly, business process outsourcing
(BPO) opportunities affect education of
women.15 In randomly selected villages in India, three years of BPO recruiting services were
provided to women primarily to increase awareness and information about the employment
opportunities. Given that the intervention was
at the level of the village, the study found large
effects—three years later, girls ages 5–15 in the
villages that received the intervention were 3–5
percentage points more likely to be in school,
had a higher body mass index (a measure of
health), and were 10 percent more likely to be
employed in wage work. Human capital investments for boys did not change. The intervention did not change either structures within the
household (for instance, the bargaining power
of the mother) or the way schools functioned.
Information about market returns alone sufficed to increase female enrollment and improve
outcomes for girls.
Changing institutional constraints. If female enrollment responded only to increasing returns,
progress would have been slower—returns can
be notoriously slow to move and can take a long

time to evolve. But even where returns have been
low, changes in the structure of formal institutions have increased educational attainment.
These pathways are perhaps best illustrated by
looking at changes in the price of schooling—
where the costs incurred could be direct (fees
and uniforms), indirect (distance to school), or
result from forgone opportunities (wages that
children could earn outside school).
Reductions in schooling fees erode the need
for families to differentiate educational investments across children. The free primary education programs launched across Sub-Saharan
Africa, for instance, increased student enrollments 68 percent in the first year in Malawi and
Uganda and 22 percent in Kenya. The abolition of education levies contributed to bringing more girls relative to boys into school and
reducing the existing gender gap in primary
education in Malawi (figure 3.4). In Lesotho,
the government launched a similar program
phased in yearly beginning in the first grade,
and participation jumped 75 percent (see figure
3.4).16 In contrast to Malawi, boys in Lesotho
have been historically less likely than girls to
be enrolled in primary school, particularly in
the higher grades. Free primary education supported a significant influx of overage boys into
the educational system.
Reductions in the distance to school have
also helped. In Pakistan, adult women who grew

Education and health: Where do gender differences really matter?

up in a village with a school by the time they
were seven years old reported higher primary
schooling than those whose villages received a
school after they were seven or those whose villages never received a school.17 In Afghan communities randomly selected to receive a school,
enrollment of girls increased by 15 percentage
points more than that of boys—over and above
a 50 percent increase in attendance for both
sexes.18 After six months, the girls in the villages
with such schools also reported far higher test
scores.
The price of schooling also reflects opportunity costs stemming from forgone child labor,
either in the formal labor market or at home
in household chores. Higher children’s employment tends to be associated with lower school
attendance.19 Employment rates for 14–16-yearold boys and girls in urban Brazil increased as labor markets improved, and children were more
likely to leave school as local labor market conditions became more favorable.20 For Ethiopia,
an increase of 10 percentage points in the adult
employment rate generated a 10–25 percentage
point increase in the probability of finding employment for youth ages 10–24.21 This effect was
stronger for youth who never attended school.
On average, boys are more likely to engage in
agricultural or other paid or unpaid productive
work: the opportunity cost of education is often higher for males than females, leading more
boys out of education and into nondomestic
child labor.22
The flip side of greater male involvement in
the formal labor market is that girls bear a larger
share of domestic labor. Households rely heavily
on children, especially girls, for natural resource
collection and caring for family members. Malawian girls ages 6–14 spend 21 hours a week on
domestic work, while boys spend 13½ hours;
in rural Benin, girls spend 1 hour a day collecting water compared with 25 minutes for boys.23
In the Arab Republic of Egypt, a 10 percentage
point increase in the probability of domestic
work—measured by household access to piped
water, piped sewerage, and garbage collection—
reduces the marginal probability of girls’ schooling by 6 percentage points.24 In Peru, in-house
water supply has a significant impact on the
grade-for-age of girls but not of boys.25 And in
Kenya, simulation models suggest that reducing
the distance to a source of water by 2 kilometers
would increase overall enrollment and attainment twice as much for girls as for boys.26

Changing household constraints. Higher and
more stable sources of household income have
helped bring girls into school even when returns
and salient institutional features remained unchanged. Household income has been tied to
greater enrollments for children—more so for
girls—and increases in maternal income have a
greater impact on girls’ schooling than increases
in paternal income.27 When households face
a sudden drop in income, perhaps because of
poor harvests, they immediately reduce investments in schooling. Whether these reductions
affect boys more than girls depends on the underlying labor market conditions.
In villages affected by droughts in Côte
d’Ivoire in 1986 and 1987, school enrollment fell
14 percentage points for boys and 11 percentage
points for girls.28 During the same period, enrollment increased 5 percentage points for boys
and 10 percentage points for girls in villages not
affected by droughts. Girls in primary and secondary schools in Turkey were more likely than
boys to drop out in the face of household budget constraints.29 Similar results are found in
countries ranging from Ethiopia (1996–2000)
to Indonesia (1993).30 In higher-income countries, by contrast, a reduction in job opportunities for school-age children brought about by
economic contractions may support investments
in schooling, as work opportunities for children
dry up.31 Typical results from Latin America—
notably Argentina, Mexico, and Nicaragua—all
show that reductions in labor market opportunities increased enrollments in school for boys
relative to girls.32
Unsurprisingly, programs that provide income to households and help them weather
economic downturns keep children in school.
Perhaps the most convincing evidence on this
front comes from studies of conditional cash
transfers—cash given to households only if their
children attend school for a minimum number
of days. Giving the household the ability to protect educational investments in children when
times are bad is precisely one of the roles these
transfers were intended to play, and the evidence
shows that they work.33

The bad news
Despite significant progress, gender disparities
in education have not been entirely erased. Girls
in many regions of the world continue to face
severe disadvantages in primary and secondary school enrollment, and across the board,

111

112

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

children in low-income countries learn little in
school. As countries grow richer, the problems
of enrollment and learning become less salient,
but girls and boys continue to choose very different fields of study in secondary and tertiary
education. These choices have repercussions for
the occupations they choose and the wages they
earn. Consider each in turn.
Severely disadvantaged populations in
primary and secondary enrollment
In specific regions, missing economic drivers
of female education combined with other areaspecific ecologies—such as poor safety, scattered
populations, and linguistic differences—give
rise to gender disadvantages, which mostly, but
not always, work against girls. These ecologies
are likely very different, and policies that finely
target local problems will vary across severely
disadvantaged populations. Six examples clarify
the problem for different populations.
Afghanistan and Pakistan are two of the few
countries where female enrollment remains low
even at the primary level. It is widely believed
that this is because households discriminate
against girls in their schooling decisions. Yet,
new evidence suggests that families are as eager
to send their girls to school as boys when the
school is close by, but are more reluctant to enroll their girls in schools that are farther from
their houses. In Pakistan, a half-kilometer increase in the distance to school decreased female
enrollment by 20 percentage points.34 Among
families living next to a school, girls are as likely
as boys to go to school in both Afghanistan and
Pakistan. Part of the “distance penalty” for girls
could reflect safety concerns in crossing settlement boundaries within the same village.35 In
this severely disadvantaged population, solving
the problem of distance to school for female
enrollment, rather than tackling any innate discrimination at the household level, will yield
large dividends.
The population in the highlands of northeast
Cambodia is scattered in remote and small villages. Lack of access to land, religious suppression, and limited learning and use of Khmer
(the national language) all marginalize these
communities and de facto restrict access to education. The indigenous Kreung and Tampuen
communities in 2001 had high child mortality
(twice the national average for children under
five) and low literacy rates—only 5 of 1,970

adults surveyed had completed primary education. There were very few schools, and grade
five completion was low; often more children
were out of school than in school. Attendance
rates varied among these villages, ranging from
10 percent to 60 percent for girls. Many out-ofschool girls were caring for siblings or working
in the fields. While most members of these communities suffered from hunger and malnutrition, girls were particularly disadvantaged—the
last to eat, they did not receive nutritious food,
such as meat.36
Of 945,000 children ages 6–14 not studying at
any school in Turkey in 2006, 194,000 said they
could not afford school expenses, while 22,000
had to work and thus could not study. Among
these children, thousands are seasonal workers.
At the crucial 14–15 age range, when children
typically transition from primary to secondary school, children in advantaged groups (in
households with fewer children living in urban
areas of better-off regions) had 100 percent enrollment compared with 10 percent for those in
disadvantaged groups (in households with more
children, living in worse-off regions).
In recent years, Jamaican boys have underachieved in school, starting in the early years
and increasing in secondary and tertiary education. With declines in boys’ participation in
secondary schooling, the gender parity ratio in
secondary education in 2008 was 1.04 in favor
of girls, with boys twice as likely as girls to repeat a grade. Apart from technical vocational
subjects and physics, girls outperform boys in
the Caribbean Secondary Education Certificate
examinations, with 30 percent of girls passing
five or more subjects compared with only 16
percent of boys.37 A recent program identifies
four key challenges in boys’ development38: low
self-esteem among young boys, violence and a
lack of discipline, masculine identities that drive
boys and young men away from better academic
performance, and limited opportunities for jobs
after graduation.
As a region, Sub-Saharan Africa stands out
in the low participation of females in schooling.
The disadvantage has narrowed dramatically
between 1990 and 2008, with the ratio of female
to-male primary completion increasing from
0.78 to 0.91. Yet girls remain at a significant
disadvantage in Central and West Africa, where
only 8 girls complete primary school for every
10 boys.39 Take Burkina Faso. Estimates suggest

Education and health: Where do gender differences really matter?

that three-fifths of the population live on less
than $1 a day and more than four-fifths live in
rural areas, many surviving on subsistence agricultural activities. Of every 1,000 children born,
207 will die before age five—the ninth-highest
child mortality rate in the world. Schooling—at
a net enrollment rate of 42 percent for boys and
29 percent for girls—is among the lowest in the
world. Not only are schools distant and difficult
to access, there often is insufficient room for
children who do enroll, and high out-of-pocket
expenses further discourage participation.40
The problems in these six severely disadvantaged populations are very different—from
distance in Pakistan and Afghanistan, to poor
economic opportunities in Cambodia, to high
costs and low income in Turkey, to violence and
masculine identities in Jamaica, to low physical access and overall poverty in Burkina Faso.
One way forward is to develop context-specific
strategies that address the specific issues. Community schools in Afghanistan have reduced the
distances girls must travel, and in villages where
these schools have been built, female disadvantages in enrollment have vanished.41 Turkey has
conducted large campaigns to promote the enrollment of girls in school, some targeting disadvantaged regions, such as “Father, send me
to school” and “Girls, off to school.” Similarly,
Jamaica is involving fathers in schooling and
making the curriculum more boy-friendly, and
a school-feeding program in Burkina Faso has
increased boys’ and girls’ enrollment by 5–6 percentage points.42
But in each of these regions, alleviating institutional or household constraints also helps—
whether by increasing supply through more
school construction or by increasing demand
through easing households’ financial constraints.
Pakistan, Turkey, Cambodia, and Jamaica all
have programs that give cash to households if
they send their children (in some cases, specifically girls) to school, and these have increased
enrollments for targeted children. The increases
have been fairly large: 10 percentage points for
primary-age girls in Pakistan, 11 percentage
points for secondary-age girls in Turkey, 30 to
43 percentage points for girls transitioning from
primary to secondary schools in Cambodia, and
0.5 days a month in Jamaica.43 Preliminary results from a financial transfer pilot in Burkina
Faso suggest similar results.44 Similarly, school
construction in countries like Burkina Faso

(through satellite schooling facilities) and Afghanistan (through community schools) helps
reduce the costs of travel and again brings girls
into school.45 A comparison of the characteristics of children in and out of school in SubSaharan Africa suggests that in 11 countries outof-school children are very similar to enrolled
children and that policies that have been effective in expanding enrollments in the past will
bring these children in.46
The precise policy to be followed depends on
the context and how much is known about it.
For instance, financial transfers to households
conditional on school attendance bring girls in.
But if the purpose of the transfer is purely to
increase educational participation (these transfers also benefit poor households directly), they
are expensive tools, because transfers also reach
households that would have sent their children
to school even without the added incentive—in
most of these countries, the cost of the transfer per additional child enrolled is close to the
country’s per capita GDP. But numerous conditional cash transfer programs are producing
results across countries, suggesting that if specific policies are hard to design, a uniform
“second-best” solution—conditional transfers
to households—could work just as well but cost
more. The problems of severely disadvantaged
populations for education could, in part, be
solved by getting more money to households—
provided that adequate educational facilities
exist.
Poor learning for girls and boys
In addition to the problems of severely disadvantaged populations, a second issue, common
to many low-income countries, is poor learning. Children in low-income countries typically learn less and more slowly relative to their
high-income counterparts. Although there are
small differences across boys and girls (where
these exist, boys tend to do better at mathematics and girls at reading), the gender difference
is dominated by the difference across countries
(figure 3.5).
To see how big these differences are, look at
the raw numbers. Only 27 percent of children
ages 10 and 11 in India can read a simple passage, do a simple division problem, tell the time,
and handle money. This low learning is not an
Indian problem; it recurs in nearly all low- and
middle-income countries. For the developing

Source: WDR 2012 team based on Edstats.
Note: The highest level is 6. In mathematics, at level 1, students answer clearly deďŹ ned questions involving familiar contexts; at level 3, students execute clearly deďŹ ned procedures;
at level 5, students develop and work with models for complex situations. In literacy, at level 1 students are capable of completing only the least complex reading tasks; at level 4,
students demonstrate an accurate understanding of long or complex texts whose content or form may be unfamiliar; at level 6, students make multiple inferences, comparisons,
and contrasts, which are both detailed and precise.

115

Education and health: Where do gender differences really matter?

countries as a whole, 21.3 percent of 15-year-old
children tested by the Program for International
Student Assessment (PISA) could not achieve
level 1 proficiency in mathematicsâ&#x20AC;&#x201D;the most
basic skills. In Argentina, the figure was 64 percent, in Brazil 72.5 percent, in Indonesia 65 percent, and in Thailand 53 percent. In a globalizing
world, the top performers also matter. Just over
13 percent of children in developed countries
perform at competency level 5 or above. Compare that with 1 percent or less in Argentina,
Brazil, and Indonesia. Clearly, fixing poor learning is imperative for both boys and girls.
The problem of stream divergence
As countries grow richer and systems of service
delivery improve, enrollment deficits for severely disadvantaged populations and the overarching issue of poor learning may become less
of a problem. But the playing field will still not
be level for women and men. Significant and
persistent gaps remain in the fields of study that
women and men choose as part of their formal
education, and the patterns of these choices are
very similar in rich and poor countries.
As with enrollment and learning, these
choices matter because, as chapter 5 shows, they
translate into gender differences in employment
and ultimately into differences in productivity
and earnings: gender differences in occupation
and sector of employment account for 10â&#x20AC;&#x201C;50
percent of the observed wage gap in 33 low- and
middle-income countries (of 53 with data). As
countries grow richer, gender disparities may
shift from enrollments and learning to segregation in fields of study. So, policy attention may
have to shift accordingly.
These gender differences in education trajectories emerge early and grow larger as young
men and women acquire more education. At
the secondary level, women are more likely
than men to choose general education and less
likely to choose vocational education. In 63 percent of countries (109 of 172), the fraction of
women enrolled in general secondary education is higher than that of women enrolled in
vocational secondary education.47 At the tertiary level, these differences magnify. Across the
world, women are overrepresented in education
and health; equally represented in social sciences, business, and law; and underrepresented
in engineering, manufacturing, construction,
and science (table 3.1).

A REFLEX (Research into Employment and
Professional Flexibility) study uncovers similar
patterns. For example, Italian men and women
are equally represented in about half the fields
of study, but large gender disparities exist in the
other half.48 Women are more likely to obtain a
degree in education and humanities, and men
in engineering, architecture, and agricultural
and veterinary science. The gender distribution
of graduates in social sciences, business, law, science and mathematics, health, and social services corresponds to that of the population of
tertiary graduates.
The sharp divergence in fields of study does
not reflect the capabilities of men and women
in different subjects. There is no systematic evidence of large gender differences in average or
subject-related ability at the secondary level.
Test scores from standardized secondary school
graduation tests are similar for men and women
in Indonesia but are slightly higher for women
with a college education in both Indonesia and
Italy.49 What matters instead is stronger sorting
on ability among men, combined with significant
gender differences in attitudes. In the REFLEX
study, male top performers on the secondary
graduation tests were 10 percent more likely to
choose a male-dominated field than other males,
while the impact of test scores on choice was insignificant for female-dominated and neutral
fields and among female top performers. Moreover, â&#x20AC;&#x153;choosing a demanding/prestigious field
TA B L E 3 . 1

Gender segregation in field of study: In most countries,
women dominate health and education studies and
men dominate engineering and sciences
Fraction of countries where the
field of study is

Number of
countries

Female
dominated
%

Male
dominated
%

Neutral
%

Agriculture

3

74

22

89

Education

84

6

10

97
97

Field of study

Engineering, manufacturing,
and construction

0

100

0

Health and welfare

82

4

13

97

Arts and humanities

55

6

39

96

Science

13

68

20

96

Services

21

59

21

87

Social sciences; business
and law

23

16

61

97

Source: WDR 2012 team estimates based on data from UNESCO Institute for Satistics.

116

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

of study” significantly increased the probability
of enrolling in a male-dominated field for men
but not for women, and it decreased the probability of enrolling in a female-dominated field
for both. Countries pay a heavy cost when the
average quality of every field is reduced because
of the mismatch between training and ability.
Stream divergence is difficult to address
precisely because it requires policies that act
on households, markets, and institutions
simultaneously.
Part of the problem lies in the educational
system, which generates expectations about
what girls and boys are “supposed” to study. For
example, some English subject textbooks currently in use in Australia and Hong Kong SAR,
China, tend to depict women in a limited range
of social roles and present stereotyped images
of women as weaker and operating primarily in
domestic domains.50
Part of the problem lies with informal institutions that influence household aspirations.
The Young Lives study looked at educational
aspirations and noncognitive skills of boys and
girls at ages 8, 12, and 15 for 12,000 children
across Ethiopia, Andhra Pradesh in India, Peru,
and Vietnam. Parental aspirations for the education of their children were biased toward boys
in Ethiopia and India by the age of 12 and toward girls in Peru and Vietnam. By the age of
15, these biases had been transmitted to children, with clearly higher educational aspirations
shown among boys in Ethiopia and India and
among girls in Vietnam. Also by age 15, measures of agency or efficacy showed a strong male
bias in India and Ethiopia but not in Peru or
Vietnam. Asked “when you are about 20 years
old, what job would you like to be doing,” 31
percent of girls and 11 percent of boys in India
chose “teacher,” whereas 35 percent of boys and
9 percent of girls wanted to enroll in university.
In Peru, 21 percent of boys (5 percent of girls)
wanted to be engineers, while in Vietnam there
were few notable differences.51
Part of the problem lies with markets and
firms that have been unwilling to experiment
with new forms of flexible production and employment that support family formation and
childbearing, even in countries where other
gender differences are notably smaller. Reducing stereotypes in education can go only so far if
there is no maternal leave down the line and the
woman has to do 90 percent of the housework,

even when she brings home all the income—as
in Ghana (see figure 5.10 in chapter 5). Reducing the time allocated to care at home will go
only so far if schooling reinforces gender norms
about what girls should study and parental aspirations feed into how much children want to
study and what they want be when they “grow
up.” And unless firms are willing to experiment
with hiring women in male-dominated occupations and vice-versa, shifting the allocation
of tasks at home or changing the field of study
is not going to help (it may even hurt). The
school system needs to say that it is acceptable
for a man to be a nurse and a woman to be an
engineer. Firms need to be willing to hire male
nurses and female engineers. And tasks at home
need to be allocated according to individuals’
time constraints and capabilities, not gender
norms. Unless all three happen simultaneously,
change will be hard.

From education to health
Despite dramatic improvements in educational
participation, much remains to be done for severely disadvantaged populations around the
world. Poor learning affects both boys and girls
and hampers the future ability of young populations to participate in an increasingly globalized
world where, as chapter 6 shows, jobs are shifting
from those based on “brawn” to jobs based on
“brain.” And girls and boys systematically choose
different fields of study in all countries; these are
choices that shape later life employment choices
and hence wages. The framework of households,
markets, and institutions helps illustrate that
progress has been rapid where improvements in
any one has helped circumvent potential bottlenecks in another; progress has been slower where
all three need to move together.
Health issues, by contrast, are different.
First, unlike education, where biological differences may play a smaller role, women and men
are intrinsically different physically and in the
health risks they face. Given the same inputs,
girls and boys may achieve similar educational
outcomes, but because of biological differences,
the same health inputs may result in very different health outcomes. Any analysis of health
issues needs to account for these fundamental
differences. Second, health outcomes reflect a
type of irreversibility that is different from that
in education outcomes. True, health and education investments during childhood and their

Education and health: Where do gender differences really matter?

timing will irreversibly affect cognitive development and learning outcomes throughout the
course of life. But a teacher absent from school
on any given day harms learning in a completely
different way from a doctor who happens to
be absent from a facility at the time a woman
goes into labor, a situation that can turn lifethreatening within minutes. So, formal service
delivery institutions will naturally play a larger
role in health, and for some health issues, they
will be the primary bottleneck.

HEALTH
Gender disadvantages in health can arise in both
sickness and death. Yet because women and men
are biologically different, ascribing gender differences in mortality and morbidity to biological
differences is fraught with conceptual dangers. If
women live longer than men (which they do in
most countries52), is it because they are biologically stronger or because there is discrimination
against men? Further, biological differences may
still be malleable: a biological predisposition
may be easy to fix, much like a pair of glasses will
fix genetically poor eyesight. But when men and
women are biologically susceptible to different
diseases (breast or prostate cancer), how can we
judge whether one is more crippling than the
other? Cutting across the conceptual issues are
poor data: in many countries, the information
on morbidity is sparse and of uneven quality.
More troubling, regions with good data may
be precisely those where gender differences are
smaller, leading to misplaced policy priorities.
To present a global picture, this chapter
adopts a reductionist approach, focused entirely
on sex ratios at birth and mortality after birth.
If the disadvantages thus uncovered are small,
it would be a mistake to argue that gender disadvantages in health are smallâ&#x20AC;&#x201D;they could well
emerge in comparisons of morbidity. But four
findings suggest that mortality disadvantages
are not small.
First, the well-known problem of skewed
sex ratios at birth in some countries remains
unresolved. Second, compared with developed
economies, the rates at which women die relative to men are systematically higher in many
low- and middle-income countries around
the world. Third, while men die more than
women at all ages in developed economies, in

many Sub-Saharan African countries the pattern is reversed, and differences are increasing,
as are overall adult mortality risks for both
sexes. Worsening female mortality rates are
particularly notable in the HIV/AIDS-afflicted
countries, but even in Central and West Africa,
where HIV/AIDS prevalence rates are lower,
mortality risks are getting worse. Sub-Saharan
Africa is the only region in the world where relative mortality risks are worsening for women.
Fourth, male mortality risks have increased in
many post-transition countries, reflecting particular types of behavior and health risks that
appear to have worsened over the last three
decades.
The findingsâ&#x20AC;&#x201D;interpreted within the framework of households, markets, and institutionsâ&#x20AC;&#x201D;
yield sharp policy conclusions. Depending
where they are in the life cycle, women and men
face disadvantages for different reasons. Missing girls at birth arise from household discrimination. Any solution to this problem has to
come through household decision-making processes. These processes can be manipulated
through markets and institutions, but markets
and institutions alone will not do the trick. After birth, although discrimination remains salient in some countries, in many other countries
high female mortality reflects poorly performing institutions of service delivery. Improving
institutions is the key to reducing female mortality. Even in populations with discrimination,
better institutions can help reduce the adverse
impacts of differential treatment. High male
mortality usually reflects types of behavior that
are socially deemed more acceptable among
men. Because there is a single point of entry for
each of these problems, solving them will be
hard. But for any notion of human justice, it is
imperative.

The facts on dying and death in
low-income countries
Some issues that this chapter highlights are better known than others: skewed sex ratios at birth
in North India and China, high female mortality in infancy and early childhood in South
Asia, and rising male mortality in some posttransition countries have all received attention
in the past decade. Less well known is that excess
female mortality is a continuing phenomenon
beyond childhood and a growing problem in
Sub-Saharan Africa. Simple comparisons of

Source: de Walque and Filmer 2011. Adult mortality rates are based on sibling rosters from 83 Demographic
and Health Surveys collected over time from 46 countries, and are estimated between 1975 and the most
current period, typically 2000; they show the likelihood of dying in every ﬁve-year period of the data.

male and female mortality risks over time help
make that point.
Of every 1,000 adults between the ages of
15 and 60 in the rich countries, somewhere
between 56 (Iceland) and 107 (United States)
men and women will die each year.53 In India,
that number rises to 213 (in China to 113). In
Central and West Africa, adult mortality rates
are higher, routinely exceeding 300 and in many
countries 400. Compare that with conflict countries like Iraq (285) and Afghanistan (479). And
in HIV/AIDS-affected countries, the numbers
rise to between 481 (Malawi) and 772 (Zimbabwe). In their mortality risks, these countries are
worse than Afghanistan (and far worse than Iraq
or Pakistan).
Comparisons over time highlight the dramatic difference between Sub-Saharan Africa
and other regions of the world (figure 3.6). Here
are the patterns54:
• Infant and early childhood mortality (underfive mortality) has declined in both Sub-

Saharan Africa and other countries, although
the rate of decline has been slower in the
former.
• Adult mortality rates in other countries have
remained roughly stable over the past 25
years, but in Sub-Saharan Africa, they doubled between 1980 and 2000.
• A large portion of this increase in SubSaharan Africa is attributable to HIV/AIDS,
with adult mortality rates in high HIVprevalence countries reaching more than half
the levels seen in the years of the genocides in
Rwanda and Cambodia—but on a sustained
and rising basis.
• Particularly surprising is the fact that adult
mortality did not decrease, and actually increased, in several countries in Sub-Saharan
Africa with low HIV/AIDS prevalence, particularly those in Central and West Africa.
Figure 3.7 uses World Health Organization
(WHO) estimates for all countries between
1990 and 2008, to show how the relative rates
of adult mortality for women and men have
changed over this period. Countries below the
solid maroon line saw a worsening of relative mortality risks for women, and those to
the right of the dashed black line saw a worsening of adult mortality (so countries in the
lower right quadrant, for instance, saw a worsening of both). Although the numbers are
not strictly comparable to those in figure 3.6
(partly because of different time periods, and
partly because of the measure of adult mortality), the broad story remains similar (also see
box 3.1).
In most countries, adult mortality risks declined. In the HIV-affected Sub-Saharan African
countries (those with a prevalence above 5 percent in 2008), mortality risks are getting worse,
and relatively more women are dying than men.
Surprisingly, a large number of African countries saw very small improvements in mortality,
with greater improvements for men; over this
period, almost no country in Africa saw relative declines in mortality risks for women. In
contrast, the majority of countries around the
world experienced declines in adult mortality
and relative improvements for women. Less surprisingly, the other main country grouping that
stands out prominently in figure 3.7 consists of
some Eastern Europe and Central Asian coun-

119

Education and health: Where do gender differences really matter?

BOX 3.1

FIGURE 3.7

Adult mortality: Over time and by sex

Declining adult
mortality, especially
for women

2
sex ratio of mortality, 2008, relative to 1990

tries, where again mortality risks have gotten
worse, but more so for males.55
In 2008, the 14 countries with the highest
adult mortality risk for women (in descending order) were Zimbabwe, Lesotho, Swaziland,
Zambia, South Africa, Malawi, the Central African Republic, Mozambique, Tanzania, Chad,
Uganda, Cameroon, Burundi, and Nigeria. Afghanistan comes in at number 15, and Pakistan
at number 64. For child mortality (under five,
per 1,000 births), the worst places for girls (in
descending order) were Afghanistan, Angola,
Chad, Somalia, Mali, the Democratic Republic
of the Congo, Nigeria, Sierra Leone, GuineaBissau, the Central African Republic, Burkina
Faso, Niger, Burundi, Equatorial Guinea, and
Liberia.
This basic description highlights the approach in the rest of the chapter. We will show
that the focus on female mortality is slowly
shifting from childhood to adulthood and
from South Asia to Sub-Saharan Africa, while
the problem of missing girls at birth remains
rooted in India and China. To do so, the argument triangulates by looking at every country
over time, by examining the historical context

Maldives

1.5

Jamaica
Iraq

India
China
Bangladesh
Iran,Islamic Rep.

1

Lesotho
Kenya
Mozambique
Eritrea
Liberia

.5

0
1

2

a. Somanathan and Hafez 2010.

3

adult mortality ratio, 2008, relative to 1990
East Asia and the Pacific
Latin America and the Caribbean
Organisation for Economic Co-operation
and Development countries
Sub-Saharan Africa: low HIV prevalence

Europe and Central Asia
Middle East and North Africa
South Asia
Sub-Saharan Africa: high HIV prevalence

Source: World Health Organization 2010.
Note: Adult mortality is expressed as the probability of death between the ages of 15 and 60. The sex ratio
of mortality is male adult mortality divided by female adult mortality.

Adult mortality risks: Who are the outliers?

Several countries in figure 3.7 highlight particular
stories, help motivate the analysis in the remainder
of this chapter, and remind us why any particular
summary of the data can be problematic, requiring
country-by-country analysis.
In Eritrea and Liberia the cessation of conflicts
around 1990 reduced mortality risks for men (and
somewhat for women). The drop in male mortality
rates, however, worsened the relative mortality risk
for women. A good thing for both men and women,
this shows how a misinterpretation can be avoided
by comparing mortality with a single reference for
all countries, instead of within countries and over
time (as the figure implicitly does).
Iraq and Jamaica saw large increases in relative
male mortality risks. In both countries, crime and
violence are taking men’s lives and increasing overall mortality risks. The link between conflict, violent
crime, and male mortality is taken up in the chapter’s discussion of male mortality and specific issues
in Sub-Saharan Africa.
Between 1990 and 2008, overall mortality risks
declined dramatically in Maldives, especially for

women, who benefited from the country’s focus
on maternal mortality and safe motherhood. The
chapter highlights the fundamental role of maternal mortality and related health issues in contributing to female mortality in the adult population.
Tonga saw large increases in relative female
mortality risks. The problems that this chapter
focuses on are absent in Tonga: It has high immunization rates among children, very few infant
deaths, and no maternal deaths in 2008. But Tonga
also has severe problems with noncommunicable
diseases and one of the world’s highest diabetes
rates: 75 percent of women are obese relative to
56 percent of men. Heart attacks accounted for
48 percent of all deaths in 2006. Although the chapter only touches on morbidity and mortality caused
by noncommunicable diseases, Tonga reminds us
that the problems today may well be different from
those tomorrow and that every region will have
its own specifics that a global report cannot adequately address.a

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WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

of the now-rich countries, and by ensuring that
the facts and interpretations are robust to alternative data sources. At the end, “stress-testing”
yields robust conclusions that point to the need
for fundamental institutional reform, better
provision of public goods such as clean water
and sanitation, and a continuation of the war
against HIV/AIDS.

Missing girls at birth and excess female
mortality post-birth
Ideally, analysis of mortality risks by sex and age
would look at the relative age-mortality profiles
of women and men across countries and over
time. But that is hard to do because it requires
comparing different age-mortality functions,
especially difficult when mortality risks across
comparison groups cross (perhaps multiple
times) at different ages. To summarize this complex data in a readily understandable manner,
the chapter computes two measures.
Missing girls at birth are estimated through
comparisons of the sex ratio at birth in countries around the world with those in comparable populations with no discrimination.56
It also computes excess female (male) mortality
by comparing the mortality risks of women relative to men in every country and every age with
those seen in developed economies today—the
“reference population.”57
This excess mortality measure is computed
for all countries around the world at three points
in time—1990, 2000, and 2008. To understand
what may drive these mortality risks, the same
measure is computed for 13 developed countries historically—in some cases going back to
1800. Changes in the relative mortality profile
by age for developed countries affect the computation of excess mortality in other countries.
So, to better interpret patterns across countries
and over time, the chapter always maintains the
same “reference” for all computations. Assumptions built into this particular summary of the
mortality data are discussed in the technical annex to this chapter.
These two computations suggest that missing girls at birth and excess female mortality after birth add up to more than 6 million women
a year. Of these, 23 percent are never born, 10
percent are missing in early childhood (under
five years), 21 percent in the reproductive years
(15–49 years), and 38 percent in the age 60 and
older group. These are the three most dangerous

periods in a woman’s life after birth. But because
women under 60 years also have the longest to
live, they account for 81 percent of the annual
years lost around the world to excess female mortality. Excess male mortality accounts for 1 million men a year, primarily concentrated in some
post-transition countries (more than half) and
some Latin American countries. Because of the
greater life-years lost to mortality before 60 and
because of greater sensitivity to the choice of the
reference group in the older years (see technical
annex), the focus of this chapter is on mortality
risks below age 60, particularly in the three critical periods for women—at birth, in infancy and
early childhood, and in the reproductive years.
While missing girls at birth are indeed concentrated in India and China, consistent with
the earlier discussion, excess female mortality
after birth is highest in Sub-Saharan Africa, the
only region where the numbers are going up
over time (table 3.2 and map 3.1). These three
population groupings—China (with a population of 1.3 billion), India (1.15 billion), and SubSaharan Africa (0.8 billion)—together account
for 87 percent of the world’s missing girls and
excess female mortality.
But the age profiles are very different. In
China, most excess female mortality is at birth.
In India, missing girls at birth and excess female
mortality in early childhood and in the reproductive years each account for roughly a third.
In Sub-Saharan Africa, excess female mortality
in the reproductive years accounts for 78 percent in the HIV/AIDS countries and 55 percent
in the low-HIV countries. Sub-Saharan Africa is
the only region in the world where the numbers
increased between 1990 and 2008—both absolutely (from 0.6 million a year to 1.1 million)
and as a fraction of the female population.
At the outset, we rule out one explanation
for excess female mortality and missing girls
at birth—lack of income growth (figure 3.8).
There is a strong relationship between income
and excess female mortality—Sweden, unsurprisingly, has lower excess female mortality than
Cameroon, but there is little or no relationship
between the change in excess female mortality
between 1990 and 2008 and economic growth
in the same period. Some countries that have
grown (Angola and South Africa) have seen little
change or a worsening in excess female mortality; others with less growth (Nepal) have seen a
dramatic decline. The lack of a relationship be-

121

Education and health: Where do gender differences really matter?

TA B L E 3.2

Skewed sex ratios at birth and excess female mortality persist across the world, leading
to females missing at birth and excess female mortality during childhood and the
reproductive years
Missing girls at birth and excess female deaths (in thousands)

Total
women
girls at birth

girls under 5

girls 5–14

1990

2008

women 50–59

under 60

1990

2008

1990

1990

2008

1990

2008

1990

2008

China

890

1,092

259

71

21

5

208

56

92

30

1,470

1,254

India

265

257

428

251

94

45

388

228

81

75

1,255

856

42

53

183

203

61

77

302

751

50

99

639

1,182

Sub-Saharan Africa

2008

women 15–49

High HIV-prevalence countries

0

0

6

39

5

18

38

328

4

31

53

416

Low HIV-prevalence countries

42

53

177

163

57

59

264

423

46

68

586

766

South Asia (excluding India)

0

1

99

72

32

20

176

161

37

51

346

305

East Asia and Pacific (excluding China)

3

4

14

7

14

9

137

113

48

46

216

179

Middle East and North Africa

5

6

13

7

4

1

43

24

15

15

80

52

Europe and Central Asia

7

14

3

1

0

0

12

4

4

3

27

23

Latin America and the Caribbean

0

0

11

5

3

1

20

10

17

17

51

33

1,212

1,427

1,010

617

230

158

1,286

1,347

343

334

4,082

3,882

Total

Source: WDR 2012 team estimates based on data from the World Health Organization 2010 and United Nations Department of Economic and Social Aﬀairs 2009.
Note: Totals do not necessarily add up due to rounding.

tween gender disadvantages in mortality and income growth is consistent with a large literature
that comes to the same conclusion.58
To examine why there are missing girls at birth
and excess female and male mortality and what
can be done about it, we need alternative explanations. Given the age-grouping of disadvantage around birth, infancy, and the reproductive
years, each of which may have different causes,
the chapter develops the arguments in turn.

Girls missing at birth—The India-China
problem
The problem of many missing girls was first
documented, separately, by Coale, Das Gupta,
and Sen.59 Subsequent studies confirm the geographical variation within India and China—in
India initially in the northern belt but gradually
spreading south, and in China a gradual spreading inland from the eastern coast.60

“

The firstborn must be male. After that
it’s all the same.

”

Young man, rural Serbia

A deadly combination of three factors led to
increasing numbers of unborn girls in the late
20th century (figure 3.9). First, fertility started
dropping as female education and the returns to
it in the labor force increased; in China, the onechild policy reduced fertility. Second, ultrasound
became widely available (allowing for prenatal
sex determination), starting from big cities and
moving to small towns and rural areas. Third,
the preference for sons remained unchanged—
families now want two children, but they want
at least one son.

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WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

M A P 3.1

In China and India, the number of girls missing at birth remains high, and parts of Africa
experienced large increases in excess female mortality during 1990–2008

Source: Staﬀ calculations based on data from World Development Indicators 2009; World Health Organization 2010; and United Nations, Department of Economic and Social Affairs, Population Division 2009.
Note: Growth is deﬁned as changes in log GDP per capita during 1990–2008. Missing women numbers are expressed as a fraction of female population in relevant age group.

To see how these factors play out, think of
an earlier time when every household had four
children. In this scenario, if the first child was a
girl, the likelihood would still be high that one
of the remaining children would be a boy. But if
households had only two children, and the first
one was a girl, there was an even chance of having yet another girl—rather than the son they
wanted. As ultrasound became available, so did
the “solution”—if the unborn child was a girl,
the parents could abort the child and try again.
Unfortunately, this is precisely what the data
indicate. In the absence of sex-selective abortion, the odds are even that the second child will
be a boy or a girl independent of the sex of the
first. The data show, however, that the probability of the second child being a boy or a girl is

“

even when the first child is a boy, but when the
first child is a girl, the second child is much more
likely to be a boy. This phenomenon has been
demonstrated in China, the Republic of Korea,
and India; for India, it is particularly strong for
educated Hindu women in northern India.61 In
addition, antenatal investments, like inoculation
against tetanus, were higher when women were
pregnant with boys rather than girls—and even
higher when the first child was female.62
These last results hold not only for northern India but also for Bangladesh, China, and
Pakistan, suggesting that forms of disadvantage
against unborn girls may be widespread across
South and East Asia.63 And they may be very
hard to change: as in their own countries, Chinese and Indians living in the United States show

Sons would ensure continuation of their family, would take care of parents at old age
and perform funeral rites when parents die.

”

Young woman, rural India

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WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

F I G U R E 3.9

Why are so many girls missing at birth?

TIONS
STITU
MAL IN
R
O
F
ce
IN
eferen
Son pr
ECONOMIC
OPPORTUNITIES

HOUSEHOLDS
Prenatal sex
selection and
lower fertility

MARKETS

FOR

MAL

INST

ITUT

ION

AGENCY

ENDOWMENTS
Unborn
Girls

S

Source: WDR 2012 team.

very similar patterns of sex selection in first and
second births.64
Not only does son preference affect the gender composition of birth, it may also affect the
way children already born are treated. One argument demonstrates the nuanced links between
son preference and gender disadvantages for already born children.65
Take again the simple framework of son preference and instead of fixing fertility, let fertility
itself be a matter of choice. In some families, the
first child will be a son. If their “stopping” rule is
the birth of a son, these will be single-child fam-

“

Lhamo was told that if she gave birth to a
daughter again, he was going to leave her once
and for all. Lhamo was soon conceived with her
third child. He would often beat her, but she was
still willing to take the chance of giving Dorji a
son so that their lives would come back to
normalcy.

”

Adult woman, Bhutan

ilies with one son. If the first child is a daughter,
the family will have another child, stopping if it
is a son and carrying on if it is a daughter. The
result? Girls will disproportionately have many
more siblings than boys.66
One result of son preference is that girl children receive less nutrition than boys in northern
India (but not worldwide, as nutritional differences show). Given the repercussions of son
preference on the different number of siblings
for boys and girls, could it be that some share of
the female disadvantage stems from the number
of siblings rather than from overt discrimination? As it turns out, once family size is appropriately controlled for, there is no female disadvantage in nutrition. That is, the entire observed
difference in nutrition between boys and girls is
attributable to the difference in the numbers of
their siblings. Gender disadvantage in the unborn child—manifest in fertility behavior—has
no further impacts on the nutritional outcomes
of the born child once fertility behavior is controlled for.
In a similar fashion, families may wait less
time to have a second child following the birth
of a girl than the birth of a boy. The desire to have

Education and health: Where do gender differences really matter?

“

Nowadays, men and women are equal.
But according to tradition, we still
prefer having a son to carry on the
family line.

”

Young man, rural Vietnam

a son following the birth of a girl may result in
disadvantages for the born female, if the mother
reduces breast-feeding to increase fertility and
hasten conception.67 The fundamental insight
from these findings is that preferences over the
unborn child drive gender disadvantage—potentially manifest in children already born.
The intersection between son preference,
declining fertility, and new technologies has
added to the number of girls missing at birth
and may well disadvantage children already
born through the number of siblings and the
timing of births. Changes in informal institutions and, through them, household behavior
are key to resolving this problem. And it can be
done. Korea, where the male-to-female ratio at
birth first increased sharply and then declined,
suggests that broad normative changes across
society brought about by industrialization and
urbanization can ultimately return sex ratios at
birth to normal ranges.68

Excess female mortality in early childhood
What causes excess mortality among girls during infancy and early childhood? One possible
explanation that has received a lot of attention
is discrimination by parents toward girls. Certainly, in parts of the world like Afghanistan,
China, northern India, and Pakistan, such discrimination is a serious problem. Studies have
shown delays in seeking medical care and lower
expenditures for girls, and in the 1990s, even in a
period of sharp economic growth, anthropometric outcomes for boys improved faster than for
girls.69 An economic rationale for such discrimination is a link to the structure of returns—for
instance, in districts within India, where the soil
is amenable to higher female labor use in agriculture, excess mortality among females is lower
than the average in India.70 Higher women’s
wages are associated with greater female mobility and authority, while higher male wages have
the opposite effect.71 Beyond economics, the

impact of kinship structures on the value placed
on girls has also been advanced as the dominant
hypothesis for why excess female mortality is
seen in some societies but not others.72
Is such discrimination against girls a widespread pattern linked to excess female mortality
in early childhood? Perhaps, as was discovered
in Bangladesh in the early 1970s and India in
the 1980s, girls are less likely to be vaccinated,
less likely to be given medical care, and less likely
to receive nutrition at home.73 But a comparison of countries around the world shows two
things. First, these differences are small or nonexistent to begin with (in Sub-Saharan Africa,
for instance, it is the boys who suffer nutritional
deprivation). Second, there is little association
between excess mortality among girls and disadvantages in vaccination, differential use of medical care, or differences in childhood nutrition
as measured through the heights and weights of
boys and girls (figure 3.10). Nor is there any association with female labor force participation.
These patterns too reflect similar findings in the
previous literature.74
Even if households treat boys and girls similarly, it could be the case that health care providers might discriminate against girls. To assess this possibility, researchers observed more
than 30,000 interactions between doctors and
patients in seven countries around the world—
Afghanistan, Burkina Faso, India, Mozambique,
Paraguay, Rwanda, and Uganda—and recorded
the time spent, questions asked, and examinations completed, all markers of medical care
that correlate with overall quality of care. Surprisingly, the main finding was that girls and
boys are treated very similarly once they are
taken to health care facilities. There were no
differences between boys and girls (or between
women and men) (figure 3.11). In all seven
countries, doctors spent the same time, asked
the same questions, and completed the same
number of examinations regardless of the sex
of the patient.75
If neither households nor providers discriminate against girls, what is the source of excess
female mortality in early childhood? Historical
forensics provide the key to this puzzle. In the
early 20th century, European countries faced
the same patterns—no girls missing at birth but
high excess mortality among girls in early childhood. Between 1900 and 1930, the excess mortality vanished in almost all of them (figure 3.12).

125

126

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

There is little or no gender disadvantage in
vaccination rates, nutrition outcomes, or use of
health services when a child falls sick

F I G U R E 3.10

Respiratory illness:
Taken to a health facility

Polio vaccination
100

Boys disadvantaged

80
60

girls, %

girls, %

100

40
20
Girls disadvantaged

0
0

20

40

60

80

Boys disadvantaged

80
60
40
20
Girls disadvantaged

0

100

0

20

boys, %

girls, %

girls, %

Girls disadvantaged

40
20
Boys disadvantaged

20

40

60

80

100

Measles vaccination
100

80
60

0

60

boys, %

Stunting prevalence

0

40

80

Boys disadvantaged

80
60
40
20
Girls disadvantaged

0

100

0

boys, %

20

40

60

80

100

boys, %

Small differences do not explain the variation
in the fraction of excess deaths across countries

change in excess female deaths
per 100,000 female population

60

The coefficient b1 on the explanatory variable
in the regression: Excess deaths = b1 x +b2 is
close to zero and almost always insignificant.

Source: Staﬀ calculations based on data from the World Health Organization 2010; United Nations, Department of Economic and Social Aﬀairs, Population Division 2009; World Development Indicators 2009; and
Demographic Health Surveys 1985–2008.
Note: Data for vaccination coverage and health service use were pooled over the years 1990–2008.

This sharp decline—after virtually no change
during the entire 19th century—was coincidental with large investments in public health, notably clean water and sanitation (broadly defined
to include waste disposal, drainage, toilets, and
vector control), along with outreach to improve

domestic hygiene practices. In the United States,
clean water and sanitation accounted for the entire decline in infant mortality during this time
and in the disappearance of excess female mortality in infancy.76
Epidemiological changes caused by these
public health investments explain both declining
infant mortality and the disappearance of excess
female mortality in infancy and early childhood.
Between the early 1900s and 1930, the share of
infectious diseases as a cause of death declined,
increasing the share of perinatal and congenital
factors.77 Although girls were (and are) more
robust than boys for both infectious diseases
and perinatal conditions, they are even more robust than boys for perinatal conditions relative
to infectious diseases. Boys always had a disadvantage in mortality, and as infectious diseases
declined, their disadvantage increased. Today, a
high burden of infectious disease in countries
where poor public health systems do not provide clean water, sanitation, waste disposal and
drainage, is part of the reason for higher relative
female mortality risks in early childhood compared with the rich countries.
If this institutional-biological hypothesis
were true today, one would expect to see less
excess female mortality in countries with lower
infant mortality. And that is indeed the case: the
relationship between excess mortality for girls
and overall infant mortality is exactly the same
in 2000 as it was in 1900 for the European countries (see figure 3.12). Bangladesh, China, and
Vietnam, which have managed to reduce overall
infant mortality through clean water and better
sanitation, have also reduced the excess female
mortality in infancy and early childhood. But in
much of West Africa, there has been less focus
on clean water and sanitation: between 1990
and 2005, the fraction of urban households with
piped water actually declined from 50 percent to
39 percent in 32 African countries. Not surprisingly, countries like Burkina Faso and Nigeria

“

Before pollution, we could cook and
drink the river water. Now oil palm
pollution has spoiled our river . . . we
have no choice but we have to drink
the water from the river.

”

Adult woman, rural Papua New Guinea

127

Education and health: Where do gender differences really matter?

F I G U R E 3.11

Men and women, boys and girls, are treated the same when they visit health facilities
Average period of time spent with practitioner at each visit and questions asked and examinations
conducted by practitioner

a. Children

Average time spent
with patient (minutes)

Afghanistan

7
6

7

Mozambique

No data available

No data available

19
25

20
27

7
6

Uganda

Average time spent
with patient (minutes)

83
85

% of essential questions
asked by practitioner

7
6

86
87
55

33
37

17

Mozambique

61
57
61

15

No data available

14
13

13
14

No data available

9

77
79

8
17

Uganda

% of essential examinations
conducted by practitioner
88

17
16.5

Tanzania

No data available

80

Burkina Faso

Rwanda

48
45

71
69

No data available

Afghanistan

female

47
50

No data available

9

Tanzania

No data available

29
28

17
18

Rwanda

% of essential examinations
conducted by practitioner

59
58

Burkina Faso

b. Adults

% of essential questions
asked by practitioner

85
86

14
male

Source: Ali and others 2011.
Note: There were no signiďŹ cant diďŹ&#x20AC;erences between boys (men) and girls (women) conditional on disease.

have seen a much slower decline in early childhood excess female mortality.
Bringing down mortality risks for boys and
girls in low-income countries today is largely a
question of providing the basic public health

services that governments in most European
countries provided in the early part of the 20th
century. Reducing the burden of infectious diseases will produce declines in child mortality,
more for girls than boys.

49
53

43
42

128

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

Excess mortality in adulthood—Women

excess female deaths per 100,000 female population,
ages 1–4

F I G U R E 3.12

Levels of excess female childhood mortality in
high-income countries in the early 1900s were
similar to those of low- and middle-income
countries today . . .

1,500

Excess female
mortality in childhood
disappeared in Europe
between 1900 and 1930

Sources: WDR 2012 team estimates based on data from World Health Organization 2010; United Nations
Department of Economic and Social Aﬀairs 2009; and Human Mortality Database 2011, Max Planck Institute for Demographic Research, and University of Califormia, Berkeley.

Excess female mortality also affects women ages
15–60, particularly women in their reproductive
years (ages 15–49) who live in low- and middleincome countries. In this age group, excess female
mortality has declined in absolute numbers and
as a proportion of population in every region of
the world except Sub-Saharan Africa, which divides into two regions: the HIV/AIDS–affected
countries, where excess female mortality has
increased even as a fraction of population; and
those countries, mainly in Central and Western
Africa, where HIV/AIDS is less of a problem
and where excess female mortality has declined,
albeit slowly. Two mechanisms drive excess
mortality in the reproductive years—maternal
mortality and morbidity related to childbirth,
and HIV/AIDS. Maternal mortality is fundamentally different from excess female mortality
at other ages in that, to reduce it, societies must
focus on an intrinsically female condition and
specifically on improving the maternal healthcare system. Throughout this Report, “maternal
mortality” implies not only death during childbirth but also concurrent morbidities brought
on by the experience of pregnancy and childbirth. These include severe anemia (and its relationship with malaria) and obstetric fistula.78
As in early childhood, adult women in some
populations around the world experience significant discrimination in health expenditures
and health-seeking behavior. But, again as with
early childhood, this discrimination does not
appear to be systematic. In countries ranging
from India to Egypt to South Africa, a small bias
favors women in overall health expenditure and
sometimes in use of the health system (chapter 1). Clinical observations of practice in seven
countries were also unable to uncover differences in the way men and women were treated
by health providers (see figure 3.11). While these
findings could still be consistent with discrimination, due to biological differences and different health needs, they also suggest that evidence
of such discrimination will be difficult to find.
In contrast, the two issues discussed next—
maternal mortality and HIV/AIDs—have very
clear and obvious pathways to women’s health,
particularly to their mortality.
Maternal mortality
In high-income countries, there were a total of
about 1,900 maternal deaths in 2008. In India,

129

Education and health: Where do gender differences really matter?

“

FIGURE 3.13

Maternal mortality ratios declined steeply in
selected countries during 1930–60
large declines
in the maternal
mortality rate
between 1930–60

800

maternal deaths per 100,000 births

there were 63,000, and in Sub-Saharan Africa,
203,000 (56.7 percent of the global total). One
of every 14 women in Somalia and Chad will die
from causes related to childbirth. As a proportion of all births, more women die in childbirth
in India today than did in Sweden at the beginning of the 1900s—and in Liberia today than in
Sweden in the 17th century.79
Between 1930 and 1960, the maternal mortality ratio—the risk of death for every birth—
fell significantly in developed countries (figure
3.13). The ratio began to drop sharply in the late
1930s in most countries, driven in part by the
introduction of sulfa drugs in 1936 and by an increase in the number of institutional births with
better care.80 The ratios then converged strongly
across countries in the 1940s and 1950s—most
countries reached modern levels in the early
1960s; Italy, Japan, and Portugal reached those
levels in the mid-1970s. Declines were sharper
in the Anglo-Saxon countries relative to the
Nordics, which already had low maternal mortality rates in 1935.
The United States stands out as the country with the highest maternal mortality ratio
for 1900–30, but like the others, sharp declines
began around the mid-1930s and fell to current levels by 1960. These declines were brought
about largely by simultaneous improvements in
the medical system at the point of delivery and
in services to pregnant women, and by shifts in
expectations of where to deliver––from home to
hospital.81
The patterns are fully reflected in changes
in excess female mortality in the reproductiveage groups for selected countries (figure 3.14).
For these countries, excess female mortality in
adulthood remained fairly high until 1930 (with

500

400

200

0
1900

1920

1940

1960

2000

Belgium

Spain

Italy

England and Wales
France
Japan
Norway

Switzerland
Denmark
Finland

Netherlands
Portugal
Sweden

Source: Albanesi and Olivetti 2010.

a spike downward coinciding with World War I
and a peak in 1918 with the flu epidemic) and
then declined sharply to zero between 1930 and
1960.82 The late declines are precisely for countries—Italy, Japan, and Portugal—where maternal mortality rate declines occurred latest.
For all countries in 1990–2008 and for highincome countries with historical data, the basic
pattern remains similar with higher maternal
mortality ratios associated with greater excess

Nobody in this village has access to drinking water. People bring water from a spring
and a water pool that are at a 100–1,000 meter distance from the village. Those also
dry out during some seasons and the children and especially the girls spend more than
five hours daily to bring water. . . .
Between the neighboring villages, sometimes violence occurs over drinking water and
residential places because there is not enough water for people and they don’t have
shelters and they make homes for themselves in the desert. And they sometimes fight
each other over this.

”

1980

year

Adult man, rural Afghanistan

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WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

F I G U R E 3.14

High income countries today had excess
female mortality at the reproductive ages
during the first half of the 20th century . . .
Excess mortality among women in 13 European
countries, 1900–2000
excess female
mortality in the
reproductive ages
disappeared in
Europe between
1930 and 1960

excess female deaths per 100,000
of female population, ages 15–49

1,000

800

600

400

200

0

World
War I
1900

1920

1940

1960

1980

2000

Belgium

Spain

Italy

England and Wales
France
Japan
Norway

Switzerland
Denmark
Finland

Netherlands
Portugal
Sweden

. . . and the excess mortality at all income levels declines with
reductions in maternal mortality

excess female deaths per 100,000
female population aged 15–49

1,000

The relationship between excess
female mortality at 15–49 and
maternal mortality has not
changed much over time

800

600

400

200

0
0

200

400

600

maternal deaths per 100,000 live births

Sources: WDR 2012 team estimates based on data from World Health Organization 2010; United Nations
Department of Economic and Social Aﬀairs 2009; Human Mortality Database 2011, Max Planck Institute for
Demographic Research, and University of California, Berkeley; and Albanesi and Olivetti 2010.

female mortality in adulthood. Reducing maternal mortality rates is thus critical for reducing
excess female mortality in adulthood. This can
be done in one of two ways—reducing fertility so that women are less exposed to the risk
of death (including the risk from unsafe abortions) or reducing the maternal mortality ratio
(the risk of death for every birth).
Take each in turn. When fertility rates are
high, reductions in the rate will reduce the risk
of dying from causes related to childbirth. Maternal mortality risks depend on the age of the
mother (slightly higher in young ages than the
average across age groups and then increasing
in older ages in a “J” shape); parity, or number
of children borne by a woman (the first pregnancy and higher parities increase mortality
risks to the mother); independent cohort effects (mothers born in cohorts that smoked
more, for instance, would have higher risks);
and time effects (later decades imply better
medical care). In rich countries, changes in maternal age and shifting parity distributions accounted for 18 percent of the decline in maternal mortality.83 Studies in a limited number of
low-income countries (typically subnational)
report similar estimated reductions of around
25 percent, using models that eliminate births
after parity five and those outside the safest
ages for birth (20 to 39). 84 So, changes in the
age and parity structure of birth in high fertility contexts could reduce maternal mortality
by 20 percent or so.
The studies from low-income countries
were for periods when total fertility rates
were high—more than 6 births per woman in
Bangladesh, for example. Today, fertility rates
are that high in just six countries—Afghanistan, Chad, Niger, Somalia, Timor-Leste, and
Uganda. Forty countries have fertility rates
higher than 4, and all but Afghanistan, Guatemala, Papua New Guinea, Timor-Leste, and
the Republic of Yemen are in Sub-Saharan Africa. For the most part, however, fertility has
declined dramatically over the past 30 years
in most low- and middle-income countries.
In countries with fertility at 3 or less, further
shifts in the age and parity distributions may
not have large impacts on the maternal mortality ratio. Because family planning policies
account for 10–15 percent of the reductions
when starting from initially high levels, these
policies could continue to help in selected

131

Education and health: Where do gender differences really matter?

F I G U R E 3.15

What explains excess mortality among girls and women in the reproductive ages?

countries but are unlikely to substantially
reduce the number of women who die from
childbirth every year.85 The best way to reduce
the unacceptably high number of women who
die from childbirth (and related causes) every
year in low-income countries will likely be region specific and will depend both on fertility
reductions and specific policies to reduce the
maternal mortality ratio (figure 3.15).
HIV/AIDS
In addition to maternal mortality, the HIV/
AIDS epidemic is contributing to excess female
mortality in Africa (figure 3.16). In Sub-Saharan
Africa, women account for 60 percent of all
adult HIV infections,86 with the gender gap in
prevalence largest for younger adults. The ratio
of female to male prevalence for 15–24 year olds
is 2.4 across Sub-Saharan Africa.87 Comparisons
of age-infection profiles for women and men
show that after age 34, HIV prevalence rates are
similar for men and women.88
Biology and behavior have both contributed
to greater prevalence of HIV among women—
referred to as the “feminization of AIDS.”89

Women are biologically 1.2 times more likely
to acquire the virus because women’s bodies are
more susceptible to infection than men. Sexually active young women, whose bodies are still
developing, may be especially vulnerable. Sexually transmitted diseases (such as herpes simplex
virus type 2) that affect men and women differently also contribute to the greater susceptibility
of women to HIV infection.90 With respect to
behavior, women date and marry men who are
a few years older, which also contributes to a differential age-gradient among men and women
in HIV infection rates.
Without treatment, HIV infection develops
into AIDS and, after 7–10 years, death. But the
HIV/AIDS link to excess female mortality in
Africa is not relevant for all countries in the
region, particularly those in Central and West
Africa. It is concentrated among the set of highprevalence countries in Southern Africa and
parts of East Africa, which bear a disproportionate share of the burden of AIDS in Africa as
well as globally (box 3.2).
Not only has HIV/AIDS hit women the hardest, but coping with the crisis has had system-

ENDOWMENTS
Excess female
deaths

132

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

F I G U R E 3.16

Excess female mortality by age in four countries with high HIV prevalence

.8
.6
.4
.2
0
0

40

20

5

0

–5

60

0

40

20
age, years

c. Uganda

d. South Africa

10

5

0

–5

0

10

age, years

excess female deaths, thousands

excess female deaths, thousands

b. Kenya
excess female deaths, thousands

excess female deaths, thousands

a. Botswana

40

20

60

20
15
10
5
0
–5

60

0

40

20

age, years

60

age, years
1990

2000

2008

Source: WDR 2012 team estimates based on data from World Health Organization 2010 and United Nations, Department of Economic and Social Aﬀairs 2009.

wide impacts on the delivery of health services.
Prenatal care, care during birth, and children’s
vaccination rates have suffered where HIV rates
are the highest in Sub-Saharan Africa.91
Encouragingly, these patterns are now changing, and so will excess female mortality, both as
life-prolonging treatment becomes available
and as incidence rates change. As of end-2009,
an estimated 5.2 million people in low- and
middle-income countries were receiving antiretroviral therapy (ART) and in Sub-Saharan
Africa, nearly 37 percent of people in need of
treatment could obtain those life-saving medicines.92 In the countries with the highest prevalence, treatment coverage varies: 83 percent in
Botswana, 48 percent in Malawi, 36 percent in
South Africa, 43 percent in Uganda, 68 percent
in Zambia, and 34 percent in Zimbabwe. This

coverage is an extraordinary achievement: as recently as 2003, only a few privileged HIV/AIDS
patients had access to ART in Africa. And it will
reduce the number of deaths from HIV/AIDS—
and decrease female mortality rates in adulthood. Botswana, Kenya, and Uganda—which
have high ART coverage rates—experienced a
reduction in excess female mortality between
2000 and 2008 (although the levels are still significantly above those in 1990). In contrast, with
a high HIV prevalence, large population, and
slower expansion of ART, South Africa saw a
steady increase in excess female mortality from
1990 to 2000 and a further increase to 2008.

Excess mortality in adulthood—Men
In some countries, the analysis illustrates patterns of excess male mortality. In the formerly

133

Education and health: Where do gender differences really matter?

F I G U R E 3.17

In some countries, there is excess male mortality
Mexico
4

excess female deaths, thousands

excess female deaths, thousands

Eritrea
0

–2

–4

–6
0

40

20

2

0

–2

60

0

20

age, years

0

–20

–40

–60
40

20

60

40

60

Thailand
excess female deaths, thousands

excess female deaths, thousands

Russian Federation

0

40
age, years

5

0

–5

–10

60

0

20

age, years

age, years
1990

2000

2008

Source: WDR 2012 team estimates based on data from World Health Organization 2010 and United Nations Department of Economic and Social Aﬀairs 2009.
Note: A value on the y axis less than zero implies excess male mortality. For example, at age 20, about 5,000 excess male deaths occurred in Eritrea in 1990.

socialist countries, in countries and regions with
high rates of violent crime or periods of war and
conflict, and in those experiencing localized epidemics of HIV in parts of the male population,
men die at a significantly higher rate relative to
men in high-income countries, after accounting
for overall mortality conditions in their country
of residence.
First, men are the immediate victims of
armed conflict. A study of conflicts in 13 countries during 1955–2002 found that 81 percent
of violent war deaths were among males.93 An
example is Eritrea, where a 30-year war of independence ended in 1991. Figure 3.17 illustrates
the significant excess male mortality that occurred there in the last full year of the war.

Outside situations of warfare, violence remains gendered: men stand charged for 80–90
percent of all violent crimes in Australia, Europe
and the United States, and the higher prevalence
of male criminal behavior translates into higher
incarceration rates for men.94 More male deaths
result from homicide than from armed conflict.
Of all violent deaths globally in 2000, just under a third were victims of homicide, the vast
majority among men. Latin America had the
highest homicide rate (27.5 per 100,000), more
than three times the rate reported in any other
region. Mexico, in particular, as a substantial
transit and production hub for cocaine, marijuana, and other illicit drugs, experienced most
of the region’s drug-related violence.95

134

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

Most victims of homicide in Latin America
are young males from low socioeconomic backgrounds, and rates peak among males between
the ages of 15 and 24 years.96 In addition to
its relation with drugs and turf battles among
competitive cartels, violence in Latin America
has also been linked to ideals about masculinity that force men to confront others when challenged. Studies of youth violence in República
Bolivariana de Venezuela, for example, show the
importance among males of ‘‘earning’’ respect
in front of others, and acts of violence are one
way to achieve this status.97 Excess male mortality in Latin American countries is precisely in
the 20–40 age group where such behavior becomes salient.
Second, the formerly socialist countries are the
location of a stark male disadvantage in health.
In addition to the economic and social upheavals
the populations of many of these countries endured, they also experienced sharply rising death
rates—the only region other than Sub-Saharan
Africa to do so during the last three decades. In
Russia, male life expectancy at birth declined by
6.6 years between 1989 and 1994 (from 64.2 to
57.6 years), and prime age men were hit hardest.
Studies have identified increased alcohol consumption and psychosocial stress, likely brought
on by changes in the economic environment and
weakening social safety nets, as the primary factors causing the spike in mortality among men.98
More broadly, deaths and disability rates related
to alcohol and substance abuse are higher for
men than for women across the world.99
In Thailand, male mortality in the late 1980s
rose as the first wave of the HIV epidemic struck
intravenous drug users, mostly men. Because the
epidemic diffused into the general heterosexual
population much later, from commercial sex
workers to their clients, and then from clients to
their spouses, the peak in mortality among men
occurred earlier and reached a higher level than
among women.100 In addition, proportionately
more women (53 percent) received antiretroviral therapy than men, who typically presented
with a more advanced stage of the disease than
women.101 Studies note the role of social norms
that condoned risky sexual behavior among
men, for whom visits to commercial sex workers before and after marriage, often in the company of peers, were widely accepted.102 Women,
by contrast, were expected to be abstinent before
marriage and faithful afterward.103

Higher male mortality, whether from substance use, violent crime, or risky sexual behavior, is not a feature of these low- and middleincome settings alone. These behaviors also
prevail among men across the industrialized
world, where women live on average 5 to 10
years longer than men. This female advantage in
longevity is not purely genetic (and where genetic factors play a role, they continue to be malleable). Studies show that differences in mortality are sensitive to environmental factors. Men
smoke more than women, have poorer diets,
and internalize stress differently. Improvements
along any of these dimensions would narrow
the gender gap in life expectancy.
This finding raises a more pertinent question:
What are the factors that mediate men’s risktaking, substance use, and increased health risks?
Do societies condone these behaviors among
men, because they reflect underlying ideals about
“masculinity” or “manliness,” at least up to a
certain point? A growing body of literature suggests this might indeed be the case, and at least
in the high-income countries health systems have
started to emphasize both “behavior” change and
institutional improvements. Although policy levers to effect behavioral change are multifaceted
and difficult to pinpoint (after all, they require
a shift from understanding the body to understanding the brain), the success of antismoking
campaigns in the West suggests that this challenge
is now being addressed around the world.104

Poor institutions and bad default options
To repeat: missing girls at birth and excess female mortality below the age of 60 account for
nearly 3.9 million women a year. Excess male
mortality, primarily resulting from conflict and
risky behavior, also leads to unnecessary deaths.
There has been little change in the numbers in
the past three decades, and in several countries
in Sub-Saharan Africa, mortality risks are worsening. The solutions for reducing female mortality risks after birth are largely institutional:
clean water and sanitation for infancy and early
childhood, and better care for expectant mothers, and reductions in HIV/AIDS and improved
family planning services in some countries for
the reproductive years.
Skeptics may question why a century of increased medical knowledge and better medical
care has not reduced the salience of the institutional provision of clean water and sanitation or

Education and health: Where do gender differences really matter?

B OX 3.2

Four Africas

Between 1980 and 2000, school enrollments in most of SubSaharan Africa increased and mortality in early childhood decreased
(albeit more slowly than in other low-income countries), but mortality risks for adults increased. Data from the Demographic and
Health Surveys show that the increases were largest among men
with less than primary education—although mortality increased
for both men and women and for those with and without primary
schooling.a Ten years later, after a period of rapid growth in many
African countries, where do mortality risks stand? And how does
Sub-Saharan Africa compare with countries in South Asia, such as
Afghanistan, India, and Pakistan, usually thought of as places with
high gender discrimination? There are now four Africas, each of
which has a different effect on women’s ability to acquire and enjoy
a healthy life: progressive countries throughout the continent,
where education levels are high and mortality risks low; the HIV/
AIDS Africa, primarily in the South; conflict countries like Eritrea and
Liberia; and, curiously, West and Central Africa.
Progressive Africa. Countries such as Ethiopia, Ghana, Madagascar, and Togo have largely escaped the HIV/AIDS epidemic. Mortality rates of children under age five are around 100 per 1,000 live
births (under 76 in Ghana). Excess female mortality after birth is
lower, and school enrollments are relatively high. Reductions in fertility rates have decreased exposure to mortality risks during childbirth; total fertility rates are now between 4 and 5. In health and
education, these countries look like Pakistan but with somewhat
higher enrollments at the primary school level. Fertility rates are
still higher than in India (2.7) and Pakistan (3.9), as are under-five
mortality rates.
Conflict Africa: Sub-Saharan Africa has experienced two types of
conflicts over the past three decades. During the 1980s and 1990s,
outright war in countries like Eritrea and Liberia claimed the lives of
many young men. Except for periodic flare-ups, these are decreasing over time. Yet the effects last. In Bargblor Town in Liberia, no one
has access to electricity, piped water, public stand pipes, or a sewage system. There is no public transport, and the nearest hospital
takes approximately 3½ hours to reach by foot. In an emergency,
women report having to run or walk to the hospital. Children who
die in the hospital are carried home to their village to be buried. In
other countries, widespread civil conflict continues to extract a
heavy toll among women. A recent study suggests that in the Democratic Republic of Congo, 29 of every 1,000 women were raped
between 2006 and 2007—58 times the annual rate in the United
States.b Excess female mortality increased between 1980 and 2008.
Total fertility rates hover between 5 and 6, under-five mortality rates

“ ”

Men are just like us, we all go through this hell
together.
Adult woman, Liberia

are between 150 and 200 per 1,000 live births, and while school
enrollments have increased in recent years, they are still low.
HIV/AIDS Africa: The third Africa consists of countries with high
HIV/AIDS prevalence. At the end of 2009, in countries such as
Botswana, Lesotho, Swaziland, South Africa, Zambia, and Zimbabwe, about one in six to one in four adults between the ages
of 15 and 49 were living with HIV/AIDS. Mortality risks during early
childhood, school enrollments, and fertility rates are similar to
those in India today. In 1990, mortality profiles for men and women
in Botswana and South Africa were similar to those in high-income
countries today. But by 2000, mortality risks increased in adulthood, more so for women. In 1980, mortality risks were higher for
more educated men, while women with more schooling and both
men and women in urban areas had a mortality advantage. By
2000–04, less educated men and women had higher mortality risks
than their more educated counterparts, and mortality rates among
both men and women in rural areas were equal to those of their
urban counterparts.

“

The worst abuse happening today is when
a man infects a woman with HIV/AIDS . . .
Unprotected sex causes fights between a
man and a woman, because a woman would
say she wants to use condom but a man
would refuse.

”

Adult woman, South Africa

Central and West Africa: The real puzzles in Sub-Saharan Africa
are the Central and West African countries, including Burkina Faso,
Chad, Mali, Niger, and Nigeria, among others (Somalia is very similar
to these countries). Except Ghana and Senegal, many of these countries have seen either no change or a worsening of overall mortality
risks during this time. In these countries, mortality risks for women
have systematically increased. Women with more than primary
schooling have seen the greatest increase in the risk of dying,
although even in 2000, urban and educated women still had lower
mortality than other groups. Today, Burkina Faso, the Central African Republic, Chad, Mali, Niger, and Nigeria look very much like
Afghanistan in their mortality risks, fertility rates, and girls’ schooling. In these countries, mortality under the age of five ranges from
170 to 220 (Afghanistan is higher, at 257), total fertility rates range
from 4.5 to above 7 (Afghanistan is 6.6), and adult mortality risks are
virtually the same as those in Afghanistan. Their enrollments in primary and secondary school also mirror the Afghan data.
These findings are puzzling because the countries in this group
have little in common. Some are landlocked, some coastal; some
are anglophone, others francophone; some fast-growing, others
slow-growing, and some have seen conflict and some have not. The

135

136

WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

B OX 3.2

Four Africas (continued)

one thing they do have in common is that women’s livelihoods,
already weak, are deteriorating.
The four Africas highlight the dramatic effects of HIV/AIDS and
conflict—and the fact that poor institutions and service delivery
can harm women just as much, or even more, than outright gender
discrimination. In determining where the international community
should focus, it is worth pointing out just how little is known about

the continent, particularly Central and West Africa. Of all papers
published in the top 202 economics journals between 1985 and
2004, 149 papers were on Pakistan and 1,093 on India—but there
were no papers on the Central African Republic, 1 on Chad, 14 on
Benin, 2 on Guinea Bissau, and 20 on Niger. Only for Burkina Faso
(47) and Nigeria (148) do the numbers start picking up. Before deciding what to do, the global community should seek to understand
what is going on.c

better maternal care. Even without clean water,
parents now know to boil water before giving
it to children. Even when children get diarrhea,
most parents know how to treat them. Households can always take pregnant mothers to hospitals. These kinds of private solutions run into
two problems. First, private actions do not take
into account the fact that sick children infect
other children as well. These “externalities” for
infectious diseases generate well known underinvestments in private behavior.
Second, while private actions work well when
there are few key choices to be made, reality can
be very different. Poor people around the world
are forced to make many, many choices—most
of them bad—every time a child falls sick: where
do they get firewood to boil the water, where
should they get sugar, should they take the child
to the doctor who could be five hours away, how
much will the doctor charge, should the mother
wait for the husband if the child needs to be carried? Each choice can have devastating consequences if things don’t pan out.
Poor people everywhere have to choose and
make many decisions about many things that
richer people take for granted every day. When
institutions are bad, so are people’s default
choices—and “free to choose” becomes “forced
to choose.” Under these circumstances, many illnesses and many life choices create excess female
mortality.
To illustrate these points, look at this example
of providing oral rehydration solution to a sick
child in a poor village:
The tall man pointed to the young woman
suckling her baby and said, “Look, look

there—that baby is burning with a fever.
I walked all the way yesterday to a nearby
town to get a pill. I spent whatever money
I had earned in the town yesterday and
trudged back late at night, but the pill has
made no difference.” I touched the baby’s
forehead—it was burning and he was sucking at the breast desperately but the mother
did not seem to have much milk. I asked the
mother if she had eaten anything. Now the
others joined in the conversation and said
that they were waiting for some of the men
to return. There was no food in the house.
They would cook something if the men
managed to earn some rice or some coarse
grain. Concerned about the baby’s condition, I asked if they knew about oral rehydration solution. They did not know anything about it—the ANM (Auxiliary Nurse
Midwife) never came up to the hamlet.. . . .
The Sarpanch (headman) who was accompanying me was getting quite defensive.
He said if these people do not come down, if
they do not tell us what troubles them, how
can we help them? I asked the Sarpanch to
explain to the young mother and the older
woman sitting next to her how important it
was for the baby to receive fluids. In his dialect, he began to explain. “You have some
salt in the house, don’t you? Well take this
much sugar, put in this much water and
boil it and then put a pinch of salt in it and
squeeze a few drops of lemon. No sugar in
the house? Yes, but go down to someone
on the lower hamlet—they may not give
you sugar if it is for yourself, but if you
say that it is needed to save the life of the

Education and health: Where do gender differences really matter?

child, they will surely give you a fistful.” The
woman nodded. “Where will you get the
water from?” I asked. Now a new problem
arose, for the nearest pump was not working. They were all drinking water from a
stream nearby that was stagnant and dirty.
The Sarpanch told the baby’s grandfather
that the water must be boiled and cooled.
I was beginning to see the hopelessness of
the situation. No sugar, no source of clean
drinking water, and a shortage of fuel. But
the man who was inebriated again got aggressive, “Whatever you say, we will not go
to anyone’s door to beg.” The women were
listening more intently and I thought they
intended to follow it up. “But do not just
feed it to him all at once,” I said, “give it in
small sips.” (How shall I demonstrate that?)
The woman took a leaf, folded it in a kind
of spoon and said, “like this?” The Sarpanch
promised to help by getting a packet of oral
rehydration solution.105
This is not an isolated story. Take maternal
mortality. Technically, much maternal mortality can be reduced if treatment is prompt and
adequate. Yet that is easier said than done. A
pathbreaking study from Ghana, Nigeria, and
Sierra Leone illustrates that even when women
are taken to hospitals, delays in receiving care
can lead to devastating outcomes:
Today, Mary, the lady who helps us in the
house, came late to work. I told her off for
being late and asked why. She said that one
of her townswomen . . . had died in the hospital while giving birth to a baby. This was
her fifth delivery. She was not from a far off
village but from Sokoto city itself. She had
not gone too late to hospital, but rather had
gone on time. . . . By the time they found a
vehicle to go to hospital, by the time they
struggled to get her an admission card, by
the time she was admitted, by the time her
file was made up, by the time the midwife
was called, by the time the midwife finished
eating, by the time the midwife came, by the
time the husband went and bought some
gloves, by the time the gloves were brought
to the hospital, by the time the midwife was
called, by the time the midwife came, by the
time the midwife examined the woman, by
the time the bleeding started . . . by the time

the doctor was called, by the time the doctor
could be found, by the time the ambulance
went to find the doctor, by the time the doctor came, by the time the husband went out
to buy drugs, IV set, drip, and bottle of ether,
by the time the husband went round to look
for blood bags all round town, by the time
the husband found one and by the time the
husband begged the pharmacist to reduce
the prices since he had already spent all his
money on the swabs, dressings, drugs, and
fluids, by the time the hematologist was
called, by the time the hematologist came
and took blood from the poor tired husband . . . by the time the day and night
nurses changed duty, by the time the day
and night doctors changed duty, by the time
the midwife came again, by the time the
doctor came, by the time the t’s had been
properly crossed and all the i’s dotted and
the husband signed the consent form, the
woman died. Today the husband wanted to
sell the drugs and other things they never
used to be able to carry the body of his wife
back to their village but he could never trace
[the body] again in the hospital.” 106
Every step of the way to delivering a baby
safely is fraught with problems, beginning with
the recognition of danger signs.107 Even when
danger signs are recognized, families “are also
aware that there is not much the medical facility can do for her when there is no trained doctor or nurse-midwife, when blood shortages
are regular, and when equipment is frequently
broken. People do not bother to seek care when
they know that they probably will not be cured,
that they are even likely to die in the hospital.”108
Even the first stage of delay—the detection of
danger signs—is unlikely in medical facilities.
For instance, a study of provider knowledge
of preeclampsia—a life-threatening condition
of high blood pressure in pregnancy—showed
that fewer than 25 percent of providers surveyed
would have referred a textbook case of such a
condition to a hospital.109 Nor are these problems restricted to maternal mortality: a study of
malaria deaths, for instance, showed that 75 percent had received care from health care providers, and some from multiple sources.110
The returns to solving these problems are
large. The poorest 40 percent in Africa have limited access to safe drinking water and are most

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likely to use contaminated water sources.111
Treatment at the point of use has a large impact
in reducing diarrhea, with similar impacts for
hand washing and sanitation (water treatment
at source is less effective because of recontamination). Increasing the coverage of piped water
and sanitation in urban Argentina reduced diseases associated with dirty water and resulted in
an 8 percent decline in child mortality.112 Similarly, access to clean water in the United States
at the turn of the 20th century led to nearly half
the dramatic mortality reduction in the country then, three-quarters of the infant mortality
reduction, and two-thirds of the child mortality reduction.113 And the returns are higher for
girls. A randomized evaluation of water treatment at source showed declines in diarrhea incidence only among girls under age of three.114
These findings have generated debate about
the relative benefits of different types of water
treatment and the willingness of households to
pay for clean water. To an outsider, not steeped
in the nuances of clean water, this debate is far
removed from the historical choices by today’s
rich countries.
Consider a randomized evaluation of water
treatment in Kenya: households were not willing
to walk 3.5 minutes more to access clean water.115
One explanation could be that learning about
the impacts of clean water is just very hard. Even
if households fully understood the etiology of
diarrheal diseases, the small reduction in overall disease burden and the lack of an impact on
nutritional outcomes could make it very difficult for an individual household to “infer” that
clean water led to better health outcomes (for
researchers, this is precisely why the impact of
any intervention on mortality is impossible to
detect unless samples are huge—certainly much
larger than what a household would have access
to). In addition, it is difficult for individuals to
handle rational calculations when probabilities
are small and the payoffs are huge.
An alternative, the historical pattern, is just to
provide clean water at the point of use through
piped delivery, ensuring that the particular
choices households make in uncertain environments with poor learning and difficult evaluative models are irrelevant—whether for how to
differentially treat males and females, or what
particular water source to use. Although this
solution is often deemed to be “too” expensive,
it is never clear what the expense is compared

with: in the United States the social rate of return for the provision of clean water was 23 to
1, once the costs of mortality were taken into account.116 Clean water is known to dramatically
reduce the burden of infectious diseases; the
argument here is that it will also dramatically
reduce the burden of excess mortality in infancy
and early childhood for girls.
Similarly, to reduce maternal mortality, the
entire system needs to work. Women need
folic acid before their pregnancy, antenatal
visits, identification of potentially dangerous
conditions, institutionalized delivery, and a
functioning hospital. Again, the myriad choices
that the current system imposes on households
(which hospital, where do I get the blood, where
do I get the medicines, how should I get to the
doctor?) need to be taken out of the equation.
These institutional solutions reduce the choices
that people make and move them from a situation where they are forced to choose to one
where they are free to choose.
Of course, there is a question of whether institutional improvements alone will make a difference even in regions where discrimination is
salient, as in parts of South Asia. Although improvements in institutions alone may not go all
the way, they will definitely help. That is partly
because when households have clean water, the
question of whether to boil the water when a
boy is sick versus when a girl is sick just does
not arise. But in addition, the link between
discrimination and mortality does not require
households to treat girls and boys in vastly different ways. Tiny differences in the ways that
boys and girls are treated can lead eventually to
large disadvantages in mortality—precisely because, at a certain time, a deadly irreversibility
sets in. Given that children fall sick 50–70 times
between birth and age five in a country like India, actions that keep boys alive 99.997 percent
of the time and girls 99.992 percent of the time
when they fall sick can account for the entire
mortality differential of 11 percent for boys versus 13 percent for girls in infancy. In contexts
where discrimination plays out in these small
disadvantages, institutions could solve most of
the problems—not by reducing discrimination
per se, but by making it irrelevant.
How institutions responsible for improving
public health through clean water, sanitation,
and maternal care can be—and have been—improved is discussed further in chapter 7.

139

Education and health: Where do gender differences really matter?

TECHNICAL ANNEX 3.1

This Report uses two measures: missing girls at
birth and excess female mortality after birth.
Missing girls at birth are computed by comparing the sex ratio at birth with the sex ratio in
comparable populations with no discrimination—typically, high-income countries, and for
Sub-Saharan Africa, black populations in the
United States.117 Excess female mortality is computed by comparing the ratio of male-female
mortality in every country and at every age with
the ratio of male-female mortality in highincome countries at the same age in 2000.118
This gives the excess female mortality at any
given age; all ages are then added up, either by
age categories or over the life course to provide
the accompanying estimates. The problem of excess female mortality in Sub-Saharan Africa that
this measure shows has been discussed in the literature.119 We discuss the assumptions required
for this method, and highlight issues that could
arise.
A natural interpretation of such a computation of excess female mortality invokes comparisons with a “reference” group of countries.
Another interpretation is that we summarize
functions of mortality profiles of women and
men by age into a single number by (a) assuming a functional form summarizing the relative
risks of men and women at every age and (b)
weighting each of these relative risks at every
age. Therefore, we are interested in measures like
∑wt.h[g(mena), q(womena)] with the summation over all ages. The first data reduction is the
functional form, h[g(mena), q(womena]=mena/
womena. The second reduction is that the set of
weights at every age, wi are the ratios of male to
female mortalities in high-income countries.
Figure 5A.1 plots relative mortality risks for
men and women at every age in five contexts—
the “reference” high-income countries; SubSaharan Africa, India, China, and the Russian
Federation. For the reference high-income
countries, the rates at which men die relative
to women are similar in early childhood, increase steeply with a peak at age 20 and then
level off with a slight hump at 60. Overall mortality rates between 15 and 60 are very low
in the high-income countries. China follows a

FIGURE 3A.1

Sex ratio of age-specific mortality, 2008

4
male mortality divided by female mortality

Computing the flow of missing girls
at birth and excess female mortality
after birth

Source: Staﬀ calculations based on data from the World Health Organization 2010; and United Nations,
Department of Economic and Social Aﬀairs, Population Division 2009,

very similar pattern; in India, relative risks in
early childhood are significantly lower, but the
curves move closer until age 50, after which
they diverge again. In Sub-Saharan Africa, relative mortality risks are similar in early childhood but worsen from age 10 onward and stay
below India throughout. In Russia, by age 20
the relative mortality risks for men are significantly higher than in the reference countries
and remain so until age 80.
For excess female mortality, weighting using the reference group implies that if men and
women die at the same rate in a country, they
will receive a higher “weight” between the ages of
10 and 30—because in the reference countries,
the differences are the largest here. This weighting matters less at ages where overall mortality
is low, but becomes important at ages in which
overall mortality is high. For excess male mortality, it is the opposite. As a consequence:
1. Any change in the reference group mortality
profile will change the computations of excess female mortality. So, throughout the
analysis, we retain the same reference group
for all comparisons.

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2. Increases in adult mortality differentials between men and women could occur due to
changes in mortality differentials at every age
(for example, behavioral changes that alter
the relative risks of mortality at each age) or
a change in the overall mortality profile while
keeping the same ratios (for example, shifting the burden of death from younger to
older ages).
3. Selection effects could bias the age-mortality
profile, especially in high mortality regions
or countries. People who survive to a particular age may be systematically different from
those who die at an earlier age. Such effects
imply that chances of survival in the surviving cohort would be different from those if
cohort members who died earlier were still
alive and part of the cohort, leading to selection biases that affect estimates of excess
mortality.
4. Using the ratio as a summary implies that excess female mortality will increase when male
mortality declines (as in Eritrea or Liberia).
The chapter investigates specific mortality
risks and ensures that the highlighted issues
do not fall in this category, alerting the reader
when they do.

number of excess female deaths, thousands

FIGURE 3A.2

Excess female mortality globally at each age in
2008 using various reference groups

1,000

at age > 60 years, the
estimates are more sensitive
to choice of numeraire

800

600

400

200

0

0

20

40

60

80

100

age
high-income countries, 2008

Netherlands, 2008

Japan, 2008

Great Britain, 1960

United States, 2008

Source: Staﬀ calculations based on data from the World Health Organization 2010; and United Nations,
Department of Economic and Social Aﬀairs, Population Division 2009,

Any summary of mortality functions will invoke assumptions; this particular weighting is
close to the mortality profiles in many countries
around the world and fairly robust to different
“reference” group comparisons until age 60.
Figure 5A.2 compares alternative computations
of excess female mortality using alternative
reference groups of the United States in 2000,
Japan in 2000, the Netherlands in 2000, and
Great Britain in 1960. Japan has unusually high
life expectancies for women; the Netherlands
has one of the lowest rates of traffic accidents
(which kill many young men); and Great Britain in 1960 represents mortality profiles before additional deaths for males from smoking
(the greatest difference in smoking prevalence
by sex was for the 1900 cohort, and smoking
results in excess deaths after age 60.)120 Excess
female mortality is similar using the different
reference groups until age 60 but diverges quite
sharply after that.
In addition to the robustness issues, choosing high-income country profiles as the weights
ensures that the risks in the reference group are
well understood, so problems that arise with
the weighting scheme are more transparent.
Choosing less researched contexts could make
it harder to understand the consequences of the
weighting scheme.
Alternative weighting measures include the
historical mortality profile in rich countries.
This literature on “missing women” focuses
on identifying female mortality solely caused
by discrimination.121 By comparing mortality profiles today with historical profiles, the
literature tries to control for the overall institutional environment and mortality risks.
In contrast, this chapter seeks not to rule out
institutional differences but to rule them in.
If historical mortality patterns reflect current
mortality profiles plus additional deaths due to
maternal mortality, a measure of discrimination would try to “control” for high maternal
mortality. In contrast, we are interested in the
fraction of female (and male) deaths that could
be avoided by focusing on maternal mortality.
There are two reasons for doing so. First, the
chapter treats all deaths equally. Using historical mortality will show that there is no problem
in Sub-Saharan Africa, but this interpretation
would be a serious mistake. There may be no
deaths from discrimination in Sub-Saharan
Africa, but poor institutions combined with

Education and health: Where do gender differences really matter?

HIV/AIDS make the continent one of the most
dangerous for women around the world. Second, improving institutions and service delivery and tackling global health issues are fundamental goals of the global community.
A final note on the data. This chapter uses
the member country life tables from the World
Health Organization for 1990, 2000, and 2008,
and population projections from the United
Nations Department of Economic and Social
Affairs. The exact numbers presented here will
change with updates to the life-tables and with

CHAPTER SUMMARY

new censuses in 2011. Despite improvements in
the data, in many countries these data are estimates based on surveys and extrapolations. Triangulating with other data sources ensures that
the results do not depend on any one particular
method. The chapter presents a global picture.
Focusing only where the light (data) shines
could miss bigger problems in the dark. The
point is not to reify existing data but to emphasize the geographical and age profile of mortality risks, leading to further analysis and better
data in the future.

In reducing gender gaps in education and health, tremendous
progress has been made where lifting a single barrier—in
households, markets, or institutions—is sufficient to improve
outcomes. Progress has been slower either where multiple barriers
need to be lifted at the same time or where a single point of entry
produces bottlenecks.

WHAT WE SEE
Gender gaps in participation in education have shrunk dramatically
at all levels, although disparities persist in severely disadvantaged
populations. In addition, men and women continue to study different disciplines, with similar patterns of segregation across poor and
rich countries. Finally, both boys and girls learn very little in school
in many lower-income countries.
Male-biased sex ratios at birth persist in China, parts of India,
and some countries in the Caucasus and the Western Balkans. Mortality risks for girls and women (relative to boys and men) are higher
in many low- and middle-income countries compared with their
counterparts in high-income countries. This “excess female mortality,” although still widespread, has declined in many parts of world.
The stark exception is Sub-Saharan Africa, where it has increased.

WHY WE SEE THIS
Education
The progress in reducing gender differences in education results
from removal of a single barrier to schooling in households (more
stable incomes), markets (increasing returns to education), or formal
institutions (lower costs of schooling). Continued female disadvantage in severely disadvantaged populations stems from an absence
of economic drivers combined with other forms of social exclusion.
In contrast, girls’ and boys’ educational paths diverge because of
multiple barriers that work simultaneously to influence choices.
These barriers are stereotypes within the education system, norms
governing gender roles in the household that constrain a woman’s
choice of occupation, and employers’ attitudes toward family formation and childbearing.

Health
Male-biased sex ratios at birth result largely from an interaction of
overt discrimination expressed in preference for sons, increased use
of prenatal sex selection, and declining fertility. After birth, however,
poor institutions of public health and service delivery lead to excess
female mortality in early childhood and the reproductive ages. In
parts of Sub-Saharan Africa, HIV/AIDS risks have compounded the
problem in the latter period.

WHAT THIS MEANS FOR POLICY
First, in education much remains to be done for severely disadvantaged populations, either through developing contextspecific strategies or by alleviating institutional bottlenecks (e.g.,
school construction), or household constraints (e.g., conditional
cash transfers). Second, improving learning outcomes is imperative
to allow both girls and boys to participate in an increasingly globalized world. Third, reducing segregation in fields of study, which will
in turn allow both men and women to develop the skills needed to
enter their desired occupations, will require simultaneous change
among households, markets, and institutions.
Changes in informal institutions that in turn change household
behavior, such as those brought about by industrialization and
urbanization in Korea, will solve the problem of girls missing at birth.
Finally, reducing excess female mortality after birth will require fixing formal institutions: clean water and sanitation for early childhood and better maternal care for the reproductive ages, along with
reductions in HIV/AIDS in Sub-Saharan Africa.

ven where gender gaps in human capital and physical assets are narrowed, differences in gender outcomes could
emerge because girls and boys, and later
women and men, have unequal capacity to exercise agency. By agency we mean an individual’s
(or group’s) ability to make effective choices and
to transform those choices into desired outcomes.
Agency can be understood as the process through
which women and men use their endowments
and take advantage of economic opportunities to
achieve desired outcomes. Thus, agency is key to
understanding how gender outcomes emerge
and why they are equal or unequal.
Across all countries women and men differ in
their ability to make effective choices in a range
of spheres, with women typically at a disadvantage. This chapter focuses on a selection of outcomes closely associated with women’s ability
(or inability) to make choices. These outcomes
are related and often compound each other; as
a result, a women’s ability to choose and act at
any point in time partly reflects foundations laid
earlier in her life, often starting in childhood.
These outcomes, or expressions of agency, are
• Control over resources—measured by women’s ability to earn and control income and to
own, use, and dispose of material assets.
• Ability to move freely—measured by women’s freedom to decide their movements and
their ability to move outside their homes.
• Decision making over family formation—
measured by women’s and girls’ ability to decide when and whom to marry, when and
how many children to have, and when to
leave a marriage.

• Freedom from the risk of violence—measured by the prevalence of domestic violence
and other forms of sexual, physical, or emotional violence.
• Ability to have a voice in society and influence policy—measured by participation and
representation in formal politics and engagement in collective action and associations.
In analyzing how economic growth, formal
institutions, informal institutions, and markets
interact to enable or constrain women’s agency,
four core findings emerge.1 First, economic
growth can improve the material conditions for
exercising agency—through higher incomes,
greater access to services, and expanded infrastructure. But the impact of higher aggregate
incomes on women’s agency partly hinges on
women’s ability to earn their own incomes; that
ability increases their bargaining power within
the household and their ability to accumulate
autonomous assets. Economic growth alone will
not eliminate gender differences in agency.
Second, expanding women’s rights can foster agency in some realms. But the expansion
of rights for family formation and control over
household resources has been limited. And the
effectiveness of expanding rights in bringing
about change depends on their applicability—
often linked to multiple legal systems—and
their enforcement.
Third, social norms shape women’s agency.
Along with markets and institutions, they determine the endowments and opportunities
that women have and whether they can exercise
the choices to use them. Norms can constrain
women’s agency when they prevent laws, ser-

Promoting women’s agency

vices, and incomes from benefiting women and
men equally. Social norms are particularly binding when increases in women’s agency would
directly shift power balances in the household
and in society. Reforms in markets and institutions, such as service delivery improvements, information provision, and creation of networks,
can reduce the bind of social norms by affecting
the costs and benefits of compliance.
Fourth, women’s collective agency can transform society. Women’s collective agency both
depends on and determines their individual
agency. Women’s ability to influence their environment goes beyond formal political channels, which can be limited by social norms and
beliefs regarding gender roles and institutional
structures. Women can influence their environments through their participation in informal
associations and through collective action, but
their success depends in part on their individual
ability to make effective choices.

WOMEN’S AGENCY MATTERS
Women’s agency matters at three levels. It has
intrinsic relevance for women’s individual wellbeing and quality of life. It has instrumental relevance for actions that improve the well-being
of women and their families. And it is required
if women are to play an active role in shaping
institutions, social norms, and the well-being of
their communities.2
• Women’s ability to influence their lives matters
in and of itself. A person’s ability to make effective choices and exercise control over one’s
life is a key dimension of well-being. Women
and men can contest and alter their conditions only if they are able to aspire to better
outcomes, make effective choices, and take
action to improve their lives.
• Women’s ability to influence their own lives
also matters for other aspects of well-being.
Agency determines women’s ability to build
their human capital and access economic
opportunities. Family formation decisions,
especially about the timing of marriage and
childbearing and the number of children, are
critical for women’s investments in education. Indeed, delays in marriage are strongly
associated with greater education, earnings,
and health-seeking behavior.3 In Bangladesh,
women with greater control over health care,

household purchases, and visits to relatives
and friends were found to have systematically
higher nutritional status (even within income groups).4 Physical mobility is also
critical for girls’ and women’s access to services—including education, health, water,
and justice—and for the development of social networks. In Zambia, women who live
fewer than two hours from health institutions are twice as likely to have an institutional delivery as those who live farther away.5
In Pakistan, greater physical mobility is associated with greater use of contraceptives and
access to care.6 In the United States, access to
contraception increased the age at marriage
and earnings, while in Europe birth control
rights increased women’s labor force participation and income.7
• Women’s exercise of agency improves their
children’s welfare. Gender differences in preferences are reflected in different patterns of
expenditure and consumption within the
household, with women more strongly favoring investments in children’s human capital. Women’s control of income and assets
is important as an instrument for child welfare. In Brazil, Côte d’Ivoire, and the United
Kingdom, women’s greater control over income increases spending on goods that benefit children.8 In Ghana, the share of assets
and the share of land owned by women
are positively associated with higher food expenditures among rural households.9 In Nepal, where mothers have greater ownership
of land, fewer children are severely underweight.10 And in Mexico, the daughters (but
not the sons) of women with greater control
over decisions within their households work
fewer hours in household tasks.11
• Women’s agency also shapes their children’s future behavior. What children see and experience in the home can influence lifelong beliefs
and behaviors. Childhood witnesses to or victims of domestic violence are more likely to
later perpetrate or experience domestic violence as adults—men who had witnessed
domestic violence in childhood were two to
three times more likely than other men to
perpetrate violence (figure 4.1).12 The perceptions of children—both girls and boys—of
what activities or behaviors are acceptable for
men and women are also often shaped in the
home. In Japan men raised by full-time work-

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F I G U R E 4.1

Witnessing violence as a child is associated with
perpetrating violence as an adult

adult men, perpetuating violence, %

60
50
40
30
20

policies in 70 countries highlights the significant role of women’s collective movements
since 1975 in promoting more egalitarian
family laws and addressing violence against
women.15 Greater representation in local political bodies, such as the panchayats in India,
has also resulted (in some contexts) in greater
allocations to some infrastructure and other
services serving women’s and their children’s
needs—as well as in greater women’s participation in village meetings, increased reporting of crimes against women, and more arrests for such crimes.16

10
0
Mexico

Brazil

Chile

did not witness father’s abuse

India

Croatia

Rwanda

witnessed father’s abuse

Source: Barker and others 2011.

ing mothers are less likely to support the division of gender roles, and in the United States
both women whose mothers worked and the
wives of men whose mothers worked are significantly more likely to work.13 Thus, women’s ability to remain safe from violence and
to exercise greater economic agency can limit
the intergenerational transmission of violence
and promote positive norms on gender roles.
• Women’s collective agency is transformative,
promoting changes in society and policy. While
individual women might have limited voice,
groups of women and girls can exert much
more pressure. Acting together they can at
times overcome constraints facing individuals. And while an individual woman’s greater
ability to exercise agency might help her
reach better outcomes for herself within her
environment and constraints, it rarely is sufficient to promote structural changes that
will reform the environment for other
women. By contrast, women’s collective voice
can contribute to changes in laws, policies,
services, institutions, and social norms that
eventually will increase women’s individual
agency. In higher-income countries greater
female representation has increased the
prominence of issues more relevant to women’s lives, including child mortality, maternity leave, child care, and violence against
women.14 An analysis of changes in gender

Overall, progress in outcomes associated
with women’s agency has been limited. Women
still control fewer assets, have less autonomous
income, and have less control over household
decisions than men. Levels of domestic violence
remain high across nations, and women have
limited voice in governments and parliaments.
The next three sections, following the analytical
framework, systematically analyze the roles of
economic growth and markets, formal institutions (laws and services), and social norms in
influencing women’s capacity for agency (figure
4.2). They show how these determinants play
a role in defining women’s agency—and how
constraints in each of them can be mutually
reinforcing.

ECONOMIC GROWTH CAN PROMOTE
WOMEN’S AGENCY BUT HAS
LIMITED IMPACT
Economic growth can promote the exercise
of women’s agency by removing financial
constraints, by increasing women’s economic
opportunities and autonomous income, and
by expanding services and infrastructure. But
its overall impact hinges on women’s greater
access to their own incomes and economic
opportunities.

Higher household incomes remove some
financial constraints to women’s agency
Higher household incomes and assets can reduce the need to ration goods or services between men and women (or boys and girls). For
example, programs in Colombia, Kenya, and
Malawi that provided cash transfers or subsidies
for school expenses increased the age at marriage

for girls and reduced early pregnancy.17 Greater
household wealth can also reduce the need for
girls to marry early to reduce the financial strain
on the household. Throughout the world girls
and women in richer households marry later on
average (although there are exceptions for some
regions or communities) (figure 4.3).
Higher household incomes and wealth can
also release financial constraints on physical mobility. The cost of transportation can be a barrier
to accessing services and information or employment opportunities and markets (chapter 5
discusses the latter in greater depth). In Brazil
and Burkina Faso about a fourth of the cost of
receiving health services in a hospital relates to
transport.18 And data from 36 countries show
that greater wealth is associated with weaker
mobility constraints related to infrastructure.19
Women in wealthier households report
having greater control over decision making,
as households enjoy greater discretionary income beyond levels required to cover basic

expenditure. In South Asia the percentage of
women who have some role in deciding on visits to relatives increases from 57 percent for the
poorest quintile to 71 percent for the richest
quintile, and the share increases from 80 percent to 92 percent for decisions over their own
earnings (figure 4.4). Similar patterns hold for
other regions.

Women’s earnings opportunities and own
assets promote their bargaining power
Another channel for economic growth (and
higher national incomes) to affect women’s
agency is through the expansion of earning opportunities. Economic growth changes employment structures in ways that typically open new
opportunities for women and create new incentives for them to join the labor force. When
higher incomes come mainly through men’s
greater earnings, the impact on women’s agency
might be muted or even negative. But higher
incomes that come through women’s own earn-

ENDOWMENTS

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FIGURE 4.3

women’s wages explains about a tenth of the
observed reduction in domestic violence.21 But
improvements in women’s economic position
can also challenge social norms on women’s role
in the household and in society and lead to an
increase in some forms of domestic violence
or threats of such violence in the short term, a
factor that needs to be taken into account when
designing interventions.22

ings increase their voice and bargaining power
in multiple ways.
There is also evidence of a relationship between women’s assets, earnings, and shares of
household income and the incidence of domestic violence. In Colombia, India, South Africa,
and Uganda, women’s asset ownership is associated with lower risk of domestic violence, at
least in the medium term.20 And in the United
States, a reduction in the gap between men and

What I make and what I buy with
my own money makes me
happy.

”

Adult woman, Vietnam

Women’s income affects their accumulation
of physical, human, and financial assets, including pensions and insurance. Together with
inheritance or programs of land redistribution, a woman’s own income is one of the key
mechanisms for the accumulation of personal
assets. And personal assets matter greatly for a
woman’s ability to exit a marriage, to cope with
shocks, and to invest and expand her earnings
and economic opportunities.
Two important assets are land and pensions.
Evidence from six countries in Latin America
suggests that markets were the second most important channel for land acquisition for women,
but a much less frequent channel of acquisition
of land than for men (figure 4.5). And in countries where transfers from the state or community are sizable, men more frequently are beneficiaries. An analysis of the factors behind these
differences points to discrimination in land
markets and to differences in incomes and access to credit.23
For pensions the patterns of wealth accumulation mirror those observed for labor market
earnings, with women around the world having
on average both lower participation in pension
systems and lower savings. Evidence from the
United Kingdom and the United States suggests
that men’s total pension assets are substantially
larger than women’s, even when the percentages
of men and women enrolled in a pension system are similar. The well-being of many elderly
women thus depends on their husband’s access
to savings and pensions and on the rules for
benefits provided to survivors once the pension

155

Promoting women’s agency

FIGURE 4.4

Women’s control is greater in wealthier households
large
purchases

100
share of women with some control
over decisions, %

holder dies. In most regimes, some mechanisms
are in place to ensure that survivors receive part
of the pension held by their deceased spouse,
but the rules can vary greatly in ways that affect
women’s agency (box 4.1).
Access to formal savings instruments helps
protect assets. And women have more limited
access to financial services than men do—in
Latin America and the Caribbean, 22 percent of
women have savings accounts compared with
28 percent of men (16 percent and 23 percent,
respectively, for debit/ATM cards) and in SubSaharan Africa, 13 percent of women and 18
percent of men have bank accounts.24
Greater economic opportunities for women
and girls can also promote women’s exercise of
agency by broadening their networks—from
mostly kin-related networks—and thus expanding their sources of information and support.
The increased physical mobility that often comes
with employment puts women in contact with
a new set of individuals at work and in other
places. When women work full time, they are actively engaged in unions or professional associations at almost the same rate as men (figure 4.6).
Women make up 44 percent of union members
(about 50 million workers) in 30 European
countries.25 In many countries, adolescent girls
tend to dedicate a significant amount of time to
unpaid domestic work, while boys focus more
on paid work or recreational time. As a result,
girls’ social networks can be thinner than those
of boys (and can weaken around adolescence).26

visits to
family/relatives

how own earnings
are used

90
80
70
60
50
40
Q1 Q2

Q3 Q4 Q5

Q1 Q2

Q3 Q4 Q5 Q1 Q2

Q3 Q4 Q5

quintiles
Europe and Central Asia
Middle East and North Africa
Sub-Saharan Africa

East Asia and Pacific
Latin America and the Caribbean
South Asia

Source: WDR 2012 team estimates based on Demographic and Health Surveys 2003–09, 40 countries.
Note: Sample of married women for control over large purchases and visits to relatives and married women
working for cash for control over own earnings.

FIGURE 4.5

100

Form of acquisition of land by gender in six
Latin American countries
4
1

8
1

6
2
8

80

7
3

8
5

7

25

37

16

4
7

9

10

16

8
34

1
7

6

16

19

33

Part of the association between country incomes
and women’s agency is related to the expansion
of infrastructure. Indeed, because of their role
as caregivers, women and girls tend to face important constraints on their time and physical
mobility that investments in electricity, water,
roads, and transportation services can mitigate.
Investments in electricity networks in rural
South Africa raised women’s employment by
almost 10 percentage points in five years. Electricity freed up time from home production for
women and expanded the types of market activities available to them (service jobs requiring
power, for example) but had no significant effect
on male employment.27 The expansion of rural
road networks and the provision of urban pub-

percent

45

Economic growth also promotes agency
through expanded infrastructure and
service provision

60

73

27

52

43
12
84

40

81

75

65

57

54
43

20

49

45

35

32

22

0

Brazil

Chile

Ecuador

Mexico

Nicaragua

Peru

women
inheritance

market

transfers from state and community

other

market

transfers from state and community

other

men
inheritance

Source: Deere and León 2003.

lic transport services can also improve outcomes
for women and girls. In rural Guatemala and
Pakistan, the expansion of rural road networks
had a strong impact on female mobility and

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WO R L D D E V E LO P M E N T R E P O RT 2 0 1 2

BOX 4.1

Pensions—Coverage, amounts, and survivor
benefits are important for women’s autonomy

Women have fewer assets in formal pension systems than men do. Even when
they work, they are less covered because they have lower earnings, work fewer
hours, and participate less in the formal sector. Data from 25 European countries show that only in 6 countries is the share of elderly women receiving a
pension (as a share of total women over retirement age) larger than the equivalent share for men. In other countries the share is as low as 40 percent (Luxembourg) or 60 percent (Austria, Greece, and Malta). In the United States currently,
women and men have similar coverage rates (around 65 percent), but the
amounts women have accumulated in their individual accounts are on average
half that of men. In China, pensions are the primary source of income for 57
percent of retired men in urban areas, but for only 35 percent of women, who
tend to rely more on family support (box figure 4.1.1).

schooling.28 In urban settings, particularly at the
periphery, the availability, cost, and efficiency of
public transport services make a difference. Long
commutes limit women’s ability to take formal
or higher paying jobs because they are not compatible with their care duties. In Durban, South
Africa, women in peripheral areas suffer poor
access to central jobs and to local amenities because of deficient transport systems.29

“

Now women can decide, there is
family planning. Before, the man used
to tell the woman how many children
to have.

Source: China’s National Bureau of Statistics, one percent population sample
data.

On the inheritance of pension rights for spouses, data from 24 countries
from all regions show that, in most countries, the wife is among the first recipients, together with her children. In Bolivia, the Philippines, and Togo, the wife’s
entitlement stops when she remarries, and the daughter’s entitlement similarly
stops upon her marriage (while sons are usually entitled up to a certain fixed
age). The conditional rules suggest that pensions for widows are conceived not
as entitlements that women have for having provided nonmonetary contributions to their households, but as mechanisms to replace the main breadwinner
until they marry another one.
In recent years, many pension systems have adopted individual accounts,
reduced the redistributional element of the system, and adopted different
annuity tables for men and women to reflect women’s longer life expectancy.
These reforms leave women with less financial autonomy in their older years.

Higher country incomes are also typically associated with an increase in the provision and
quality of public services. Such services can expand women’s exercise of agency. For example, reproductive health services can help women (and
men) make decisions about their own fertility.30
Indeed, many young men and women surveyed
for the qualitative study on gender and economic
choice prepared for this Report said family planning services were instrumental in shifting decision making about having children from the
male to the couple.31 Although the availability
of modern contraceptives has increased significantly over the past decades in most countries,
in line with rising incomes, and these services
are widely available, constraints remain. The
main ones, cited by two-thirds of women, were
health concerns or opposition to contraceptives
(figure 4.7). However, in line with increased access, only 8 percent of the women surveyed said
lack of access and issues of cost were the main
reasons they did not use contraceptives. The role
of intrahousehold bargaining over fertility con-

“

If they know about family
planning, they both decide
[how many children to have];
knowing about family planning
helps.

”

Young man, Papua New Guinea

157

Promoting women’s agency

RIGHTS AND THEIR EFFECTIVE
IMPLEMENTATION SHAPE WOMEN’S
CHOICES AND VOICES
Among formal institutions, laws formalize
women’s rights and provide the framework that
defines the environment in which women exercise agency. Many laws reflect different treatment of men and women in the past or are the
formal recognition of unequal social norms and
practices. So, ensuring that laws treat the two
sexes equitably can be instrumental in reversing
the status quo. Acknowledging rights has been a
critical force behind women’s ability to express

FIGURE 4.6

Working outside the home broadens men’s and
women’s networks (almost) equally

80
percentage men and women members
or active members

trol is illustrated in Zambia, where women used
contraceptives more frequently when they could
hide the use from their spouse.32
But in a few countries and for some population groups, supply remains a significant
issue—in Burkina Faso, Mozambique, and the
Philippines, around 20 percent of women in
need lacked access. And poverty also constrains
access. For instance, almost 18 percent of the
poorest fifth of women in need lacked access
to contraception in Benin and Indonesia, compared to only 3 percent of the richest fifth. Also,
the transition to sexual maturity can be difficult
to navigate for adolescent girls, who tend to have
limited knowledge of reproductive health and
contraception. They also tend to have limited
bargaining power, and many experience unwanted sexual encounters.33 Social norms that
disapprove or condemn their sexual activity may
discourage these girls from seeking reproductive
health services; in some countries, young girls
must have parental consent before they can receive such services.34 As a result, about 60 percent of unsafe abortions in Sub-Saharan Africa
are performed on girls and women ages 15–24;
worldwide, an estimated 25 percent of unsafe
abortions are performed on girls ages 15–19.35
Even when country incomes and women’s
agency are associated, the association varies
greatly across countries and outcomes, suggesting that many aspects of agency are driven by
other factors. Formal institutions—laws and
services—can impose or ease constraints on the
exercise of agency. And prevailing social norms
and their associated beliefs can promote or restrict its expression.

Source: WDR 2012 team estimates based on Demographic and Health Surveys 2004–09, 38 countries.
Note: Sample of men and women working full time.

their voices, make choices, and accumulate assets in many countries.
But the power of laws in increasing women’s
agency can be limited by four factors. First, discrimination persists in many formal statutory
legal systems, particularly around marriage and
control over resources. Second, customary laws
in many countries have large spheres of influence, especially in relation to family law. Third,
the enforcement of rights—and the ability of
women to seek redress or to demand that their
rights be enforced—is critical if rights are to have
an impact on women’s ability to exercise agency.
Fourth, markets and social norms interact with
laws, either limiting or enhancing their impacts.

Rights matter for women’s agency
Voting rights for women are now near universal. Head of household rules in Napoleonic
codes, the doctrine of couverture in common
law statutes, and religious or customary law that
restricted married women’s legal capacity and
their right to work have been reformed in many
countries, although a few exceptions persist.
Changes in other laws can promote women’s
agency. Indeed, many laws can increase women’s

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F I G U R E 4 .7

In most countries, access to contraceptives is a less significant
constraint than lack of knowledge and opposition to contraception

Share of women citing reasons for not using contraceptives, %
issues of access, distance, or cost

health concerns, fear of side effects, inconvenient to use

lack of knowledge of method or source

opposition by woman/partner or religion

Source: WDR 2012 team estimates based on Demographic and Health Surveys 2003â&#x20AC;&#x201C;09.
Note: Sample of women who do not want children in next two years, are fecund, and do not use contraception.

autonomy even if that was not their intended objective. For example, laws requiring compulsory
education have delayed marriages and childbearing, increasing womenâ&#x20AC;&#x2122;s agency. In Turkey, where
out-of-wedlock birth is not socially accepted, the

legal extension of compulsory schooling by three
years in 1997 (to age 14) reduced the proportion
of 16-year-old girls who were married by 45 percent and the percentage of those giving birth by
age 17 by 36 percent.36 While the share of women

Promoting women’s agency

who eventually marry or the number of children
they eventually have was not affected, the timing
matters because early marriage and childbearing
reduce educational achievements and thus earnings and agency in adult life.
Laws that increase control over income and
assets may improve women’s position within
their own households by strengthening their
ability to leave marriages (“exit options”) and
increasing their bargaining power. The improvement in the legal status of girls can also, by increasing their value, induce other changes: investments in girls’ education may increase, ages
at marriage may increase, or childbearing may
be delayed. For example, reforms to inheritance
laws in India resulted in delays in marriage for
girls, more education (increasing the number of
years of schooling by an average of 11–25 percent), and lower dowry payments.37
Laws that allow or facilitate divorce can also
increase women’s capacity to choose. For example, laws that enable women to seek divorce and
that provide for equitable financial provisions
affect the spouses’ work and income transfers
within households. In countries where women
receive half the household’s wealth upon divorce,
women may work fewer hours because they feel
more sheltered by the prospect of an equitable
division of marital property.38 In the United
States, these laws also reduced investments in
marriage-specific capital, such as investments in
the education of a spouse (although home ownership was not affected) because of the increased
risk of losing the asset upon divorce; domestic
violence also fell by around 30 percent.39

Progress in areas that regulate relations
within households has been limited
Progress in improving laws has been slowest in
areas that regulate relations within households.
Many programs and policies seem to stop at the
household’s doorstep and avoid interfering with
relations within households. This resistance is
also reflected in the reservations that countries
make when signing up for the Convention to
Eliminate All Forms of Discrimination against
Women. Of the 187 countries that have ratified the convention, 29 have not fully endorsed
article 16, which calls for the elimination of
discrimination in all matters relating to marriage and family relations, including the right
to enter marriage; the right to freely choose a
spouse; equal rights in marriage and its dissolu-

tion; equal parental rights and rights over children; equal personal rights as spouses; and equal
rights in ownership, acquisition, management,
and disposition of property.40
Women now have the legal ability to own
assets in most countries, but men and women
still have different ownership rights in at least
nine countries.41 Women may be restricted in
acquiring, selling, transferring, or bequeathing
property, and the consent of a male guardian or
husband is needed before a woman can make
any purchase, sale or, transfer of assets. In some
cases, a woman may control only a portion of
her personal property. Any breach of these limits could trigger a husband’s right to administer
a wife’s personal property. In some cases, even
property registration may require the consent
of a male guardian. Citizenship laws may prevent women from passing on their nationality to
foreign husbands or their children. This matters
because lack of citizenship can limit access to
state benefits such as free education and curtail
the extent to which national laws apply.
Inheritance is one of the main mechanisms
for the accumulation of assets. In many countries, women and girls still have fewer inheritance rights than men and boys. In 21 of the 63
countries that have data for more than 40 years,
women have unequal inheritance rights (in the
absence of wills) (figure 4.8). This is particularly
relevant in Sub-Saharan Africa, where fewer
than half of widows (or their children) report
having received any of their late husband’s assets
(data from 16 countries, see box 4.6). All countries in the Organisation for Economic Co-operation and Development (OECD), the former
Soviet Union, and Latin America reformed their
inheritance laws more than 50 years ago. NonOECD countries that have a common law legacy
or that recognize customary or religious law are
more likely to exhibit unequal rights for sons
and daughters. Among majority Muslim countries, there are important doctrinal differences,
with some granting greater inheritance shares
for girls. In Turkey, inheritance rights for boys
and girls have long been equal in practice as well
as in law. And in the Islamic Republic of Iran,
girls’ share of inheritance is generally equal to
boys. In other countries, such as Bangladesh, the
law provides for unequal inheritance rights, but
mechanisms exist for families to agree on more
equitable distributions if they so desire. Finally,
in a few countries, such as Bhutan, girls inherit

159

160

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F I G U R E 4 .8

Progress on inheritance is faster for daughters than for widows
(percentage of countries with equal, unequal, or customary inheritance)

Daughters

Widows
Middle East and
North Africa

100

50

50

59

7

25

100

0

East Asia and Pacific

46

75

OECD countries,
Latin America
and the Caribbean,
and Europe and
Central Asia

Source: WDR 2012 team estimates based on Htun and Weldon 2011b, Women Africa database, and World Bank’s Gender Law Library.
Note: Countries are given equal weight in the calculation of regional percentages.

most of their parents’ property, and property
titles are mostly in women’s names.42
Even when countries reform their laws toward
more equal treatment of men and women, important differences can persist. In India, amendments to inheritance legislation that granted
sons and daughters equal rights in joint family
property in a few states significantly increased
daughters’ likelihood to inherit land, but the legal change alone was insufficient to fully compensate for females’ underlying disadvantage.43
Laws are sometimes ignored or weakly enforced
or may be circumvented through the making
of wills (for example, when families explicitly
choose to give more to sons than to daughters).
Some countries with systems based on religious
laws limit the discretion individuals have in designating their heirs (or provide venues for challenging a will), helping to ensure that women’s
share of the inheritance is protected. The same
approach is sometimes found in nonreligious
codes. In Brazil, wills have to give at least half
the estate to children and widows, and boys and
girls must inherit equally. This requirement

leaves discretion in the allocation of the other
half of the estate, which individuals can choose
to pass on only to their sons, but it does offer
some protection for girls and widows.44
Rights in marriage and its dissolution are
critical for women’s agency
In many countries, legal systems do not uphold
equal rights for women at all stages of the life
cycle. Marriage is a milestone that sometimes
weakens women’s legal and property rights. In
some cases the legal capacities and responsibilities women have before marriage are transferred
to their husbands upon marriage. In some countries marriage reduces women’s civil capacity—
by preventing them from applying for a passport, entering a contract, or appearing in court
without their husbands’ permission.
The impact of marriage is also felt in property regimes that stipulate the amount of assets
women can control, both during the marriage
and in case of divorce. The type of property
regime can thus shape the bargaining power a
woman has within her household. A property

Promoting women’s agency

regime that allows a woman to leave a marriage
with a significant share of household assets—
lowering the cost of leaving the household and
hence making the threat of leaving more credible—might increase her bargaining power, even
if she never exercises that right. Conversely, a regime that limits women’s control to the assets she
brings to the marriage—which are often fewer
than those brought by men45—or to assets she
acquires herself, limits her bargaining power.
Countries in Latin America and Africa previously colonized by France, Belgium, Germany,
the Netherlands, Portugal, or Spain were largely
shaped by old codes that they inherited and typically have community of property as a default
(box 4.2). Countries from the former Soviet bloc
also usually have default community of property regimes. Countries shaped by common or
by Islamic law, and countries where polygamy is
formally allowed, typically have separate ownership of property as a default (Turkey, with community of property as the default, is an exception among Muslim-majority countries).
Sixty percent of the adults in the WDR 2012
qualitative study on gender and economic choice
reported that divorce is difficult, and younger
adults have only a slightly more positive view.46
Lack of fairness (for women) in the division of
assets and custody of children was one of multiple obstacles to divorce mentioned by both men
and women surveyed. Opposition by families and
communities, social isolation, and stigma were
also identified as key impediments to divorce.
For many women across the world, widowhood is associated with a critical loss in the use
and control of assets, because their husband’s assets revert to his family, and the widows lose control and at times the use of the land and house
(box 4.3). While widows are protected in countries with community of property regimes, their
situation under separate ownership regimes is
weaker. Indeed, default inheritance rights usually
award less than half of the estate to the widow;
the usual share in Sub-Saharan African ranges
from 0 to 30 percent, and customary land is at
times excluded from the property widows can
inherit (with exceptions in matrilineal societies).
In many countries, reforms to strengthen the
rights of widows are less advanced than reforms
to strengthen the rights of daughters (see figure
4.8). While major reforms affecting women have
occurred in other areas of family law and land
laws in Kenya, Morocco, Tanzania, and Tunisia,

“

They [divorced women] come to their
parental home after divorce, but they get
no alimony or share of the property from the
husband’s side, nor do they get any share of the
parental property. . . . In some cases, they are
forced to remarry an elderly man so that they
can earn a living by working in their master’s or
husband’s ﬁeld.
Adult woman, India

When you die, your property is distributed by
your relatives, and does not go to your wife or
daughter. If you have a son, all property will
belong to the son.
Young woman, Afghanistan

[Family law] has assisted us. When you leave
the man’s home, you divide the property
and go with something to begin your
new life.

”

Adult woman, Tanzania

inequalities affecting widows persist. This shortcoming is partly linked to the underlying premise that male relatives are obliged to look after
dependent female relatives. But this obligation is
not always fulfilled. Lessons from reforming inheritance rights for daughters could be extended
to widows’ rights. Community of property regimes may also help widows where inheritance
and intestacy laws do not allow for a 50 percent
share. Citizenship laws should also be a focus for
reform, because they can also confer rights that
affect women’s access to benefits and property
for themselves and their families and may be
more easily changed than personal laws.
Arrangements for the custody of children after divorce can deter a woman from leaving a

“

It can get very litigious because
now that there are laws stipulating
individuals’ rights, compensations
are bigger and people are aware of
the law.

”

Adult man, Bhutan

161

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B OX 4.2

Property in marriage (and divorce)

Community of property. This regime typically gives protection to
the wife in case of divorce, usually splitting marital property equally
between the spouses. All property acquired during the marriage is
owned equally between spouses (personal property owned before
the marriage and property inherited or received as a gift to a spouse
may remain the property of that spouse). In a universal community
of property regime, property acquired by the spouses before the
marriage also becomes joint marital property. This regime implicitly recognizes nonmonetized contributions to the household
(including care, childrearing, household chores, or subsistence
agriculture), and there is no requirement of proof of contribution.
Under this regime some countries still give husbands the power to
administer joint marital property during the marriage, depriving
women of control (a leftover from the colonial codes). That is the
case in 10 of the 43 countries surveyed that have had community of
property as the default regime over the past 50 years—including 8
Sub-Saharan countries, Chile (the only country of Latin America to
retain this provision), and the Philippines (which reformed its family
laws but retained this provision) (box map). France removed its provision in 1985.
Separate ownership of property. Spouses have ownership of any
property they acquire during the course of a marriage. This regime
protects women entrepreneurs, who can keep control of their productive assets on divorce. But it tends to penalize most women,
because, unless legislated for, nonmonetized contributions are not
recognized upon divorce (and women typically have fewer monetized contributions than men and thus fewer assets of their own
during marriage). A few countries have added provisions to marriage laws that recognize women’s nonmonetized contributions
(although in many countries these contributions are assumed to be
less than men’s).

Of the 35 countries whose laws on separate ownership of property were surveyed, only 7 recognized nonmonetary contributions
(including Bangladesh, Malaysia, Morocco, and Tanzania). Nonmonetary contributions have not traditionally been recognized by customary or religious law in Sub-Saharan Africa. In Muslim-majority
countries, the practice of Mehr (dowry given to the bride on marriage) does provide for women who divorce, but the value in some
cases can be too low to put women on an equal footing. Some
countries have tried to increase its value, as in Bangladesh, or index
it to inflation, as in the Islamic Republic of Iran, where women are
also classified as priority creditors and their right to Mehr is superior
to the claims of all other creditors. Some Muslim countries such as
Morocco and Tunisia allow optional marital regimes of community
of property, and the latter is the default regime in Turkey.
Customary regimes. These regimes are the default in only four
countries in Africa—Botswana, Burundi, Nigeria, and Swaziland.
They are generally disadvantageous to women, with men traditionally administering marital property and with no recognition of nonmonetized contributions. Husbands usually have control over the
assets during marriage. In some cases women even lose the property they brought into the marriage upon divorce.
Multiple regimes. In some countries, multiple regimes are available,
and each couple can select from among them. While women theoretically could choose the regime that offered them the most protection, most couples opt for the default regime. For instance, family law reforms in both Morocco and Tunisia have meant that couples
can opt out of the separate ownership regime and chose the community of property regime, but in practice use of that option has
been limited. Choosing the default marital regime is thus an important policy decision.

B OX M A P 4. 2. 1 Women in different parts of the world have different control over assets—Which matters in case of divorce or the husband’s

death

Community of property
Community of property (with husband control)
Separation of property and recognition of non-monetary contribution
Separation of property, no recognition of non-monetary contribution
Separation of property no recognition of non-monetary contribution (with husband control)
Customary law & husband control
No data

Source: WDR 2012 team estimates based on Htun and Weldon 2011b, Women LEED Africa database, and World Bank Gender Law Library.

163

Promoting women’s agency

B OX 4.3

Widows risk losing their assets but might gain some freedom

Risks of reversals in autonomy appear after the death of a spouse—
a threat that disproportionately affects older women, who are
nearly three times as likely as old men to lose a spouse. Given longer female life expectancy and the age differences between husbands and wives, far more women than men experience the death
of a spouse at some point in their lives. In Mali many young women
find themselves widows with few rights, and their children are more
likely to be undernourished and out of school, suggesting an intergenerational transmission of poverty stemming from widowhood.
Moreover, across the world among the elderly who do not live in an
extended household, more women live alone, and more men live
with their spouses (box figure 4.3.1). Men are also more likely than
women to remarry.
B OX F I G U R E 4. 3. 1 Elderly women are more likely to live alone and

elderly men with their spouses
United States
Latin America
and the Caribbean